I had a full knee replacement in July 18' had I not gone to Helen Hayes Center For Rehabilitation I never would have made it thru they helped me so much. That being said I'm still not 100% and its been recommended I have the other knee replaced. I don't think I will.
6
I had bilateral knee replacements three months ago. I spent a few days in the hospital then moved to an orthopedic rehab for 13 days. This was the best thing I ever did for myself. Intensive physical therapy in the rehab, three to four hours a day 7 days a week allowed me to come home with just a cane and live alone in perfect safety. I was back to work less than 6 weeks after surgery. Within days after getting home I started outpatient Physical Therapy 3 times a week for two hours each session, and that will continue for another couple months. My surgeon and my physical therapist believe that I won't have any problem reaching at least 120 degree flexibility. My stay in rehab is what set me on a path to recover from the surgery as quickly as I have. The pain for the first 2 weeks after surgery was wicked intense, and was no joke. But because I was in rehab it was well managed by professionals, much more so than I would have been able to do at home. So yes, it would have been cheaper for the insurance company had I come straight home after the surgery. But there's no way I would have been back to work six weeks after the surgery, back to contributing to the economy and back to climbing subway stairs without the flawless surgery by Dr. Timothy Reish, excellent care in Rusk Brooklyn Orthopedic rehab and current outpatient Physical Therapist Leora at Northwell STARS. It's all about finding the right people and the internal motivation to do your PT work.
11
Keep in mind that the individuals that are discharged to inpatient rehab facilities are probably the ones who have multiple co-morbidities, more physical impairments, and less function and quality of life before the surgery. These patients are probably more predisposed to "adverse events" and complications than the patients discharged home. This variable can be controlled for through a randomized controlled trial such as the first one noted, but is not controlled for in a cohort study, such as in the 769 patient study by Dr. Parvizi's team (as I understand from the article)...I may be making incorrect assumptions from the article, and would like to first look at the Thomas Jefferson study, but something to keep in mind.
4
Both my knees were replaced on the same day. I was 62 and it was one of the best decisions of my life. Having had 2 previous unrelated surgeries I knew I did not want to got through this twice. My surgeon was reluctant, but because I am blessed with good health, he agreed. The hospital encouraged me to go to the rehab facility but I wanted none of it. I wanted to be in my own home. Recovery was no picnic. I live alone, had 3 dogs at the time, and a small group of wonderfully helpful friends. I stocked up on microwaveable food from Trader Joe's and followed my doctor's and visiting physical therapist's instructions diligently. After 2 weeks, friends would take me to my usual physical therapist 3 times a week. The therapy is hard. The most important thing that some people do not realize is that, yes, you have a shiny new knee but all the soft tissue around it was pretty well beaten up to get it in there. Scar tissue can build up very quickly and needs to be broken down. I am convinced that this is why we hear so many horror stories. Some people just don't do their work. I had my surgery on October 20th. On January 18th I went skiing, something I had not been able to do for several years. I was overjoyed.
6
I have no trust about any medical advice out of Australia! This is the same country that tells patients with bronchiectasis that manual percussion done at home is just as good as a percussion vest and will not pay for a vest. And just who is to do this manual percussion? The dog? A neighbor? Twice daily for the rest of ones life? One can only rely on the "kindness of strangers" for so long!
I know innumerable people who have had knee replacement surgery. All but one, were widows and lived alone. They also had children with full-time jobs who would have had to give up family vacation time in order to come and care for their parent. All went to rehab facilities for 7-10 days and it was the right thing to do. The one who went home had a husband who proved to be useless and a year later, she is still having trouble with her knee.
I'm all for saving needless costs for medical, but not going to a rehab facility is not the place to do it. Most people having this surgery are old - at least in their 70's. Many have other medical conditions - by that age most people have at least one. The majority live alone. Most hate to bother their children who have very busy lives. They need rehab.
I know innumerable people who have had knee replacement surgery. All but one, were widows and lived alone. They also had children with full-time jobs who would have had to give up family vacation time in order to come and care for their parent. All went to rehab facilities for 7-10 days and it was the right thing to do. The one who went home had a husband who proved to be useless and a year later, she is still having trouble with her knee.
I'm all for saving needless costs for medical, but not going to a rehab facility is not the place to do it. Most people having this surgery are old - at least in their 70's. Many have other medical conditions - by that age most people have at least one. The majority live alone. Most hate to bother their children who have very busy lives. They need rehab.
9
At home rehab is only as good as the will of the patient. Many need prodding that can only be achieved in a facility. And the first few days when mobility is almost non-existent -- truly a brave new world.
5
I notice that there are no comments about hip resurfacing. Perhaps because there are several significant advantages to this solution to fixing hips, leg length issues are extremely rare for example.
I had my right hip resurfaced in 2001 and it has never given me a hint that it was anything other than a normal hip after an adult life living with dysplasia. I have had sixteen years of playing sqash at a high level in the various age groups that I have passed through.
Anyone needing hip surgery should look into hip resurfacing rather than replacement.
I had my right hip resurfaced in 2001 and it has never given me a hint that it was anything other than a normal hip after an adult life living with dysplasia. I have had sixteen years of playing sqash at a high level in the various age groups that I have passed through.
Anyone needing hip surgery should look into hip resurfacing rather than replacement.
5
I am really surprised with all these positive reviews when I know of many negative reviews of this surgery. Especially hip surgery and witnessed those still in great pain a year later.
3
You had both knees done at once! Holy cow. It's almost a year since my 1 knee, I'm not overweight and PT came here 3x/week for 9months. You must be Wonder Woman. I can't even imagine it and as good as the new one is, the other will be bone on bone while I try to build muscle around it as I'm 70 and have had it with hospitals/surgery.
But I salute you. Now you're done, don't be too hard on them!
But I salute you. Now you're done, don't be too hard on them!
5
I have had both hips replaced. I think that living alone in a two and a half story house without a powder room and a dog was the best therapy possibly. I stopped physical therapy when they could not clearly stare the goals that would signify I needed PT. I cynically wonder if that would have happened only when my insurance ran out.
4
Ms Lytle,
Your letter caught my attention immediately as most people aren't aware that a hip operation can result in leg length discrepancy - my operated hip caused the leg to be one inch shorter. And two years later it caused my knee to be replaced on that shorter leg. I need to take painkillers every day, can barely walk, can't swim, exercise, stand for more than a few minutes or travel. The irony of this is that at age 75 I have no health problems at all but for those replacements. You might do better because you live in a place that has better medical care than I have here in MS.
Your letter caught my attention immediately as most people aren't aware that a hip operation can result in leg length discrepancy - my operated hip caused the leg to be one inch shorter. And two years later it caused my knee to be replaced on that shorter leg. I need to take painkillers every day, can barely walk, can't swim, exercise, stand for more than a few minutes or travel. The irony of this is that at age 75 I have no health problems at all but for those replacements. You might do better because you live in a place that has better medical care than I have here in MS.
7
Why is there no mention of the possible complications? Some of them are severe indeed, and lead to more surgery. This article takes a very light-hearted view of this serious surgery, and seems to suggest it's normal for most people. It's not.
(I personally think the NYT should have Jane Brody replaced. She is not keeping up with research.)
(I personally think the NYT should have Jane Brody replaced. She is not keeping up with research.)
14
A bone on bone right knee has plagued me for 4 years, only getting worse. Two weeks ago, after several injections which helped less and less, I began accupuncture. Relief has been incremental since they began, allowing me to put off what I know is inevitable....full replacement.
1
This home-based rehab after knee replacement: would that apply to someone (like me) who lives in a third-floor walk-up?
9
Saving $10,000 is chump change compared to the total cost of bilateral knee replacements.
No way could I have replaced at home the wonderful work done by the rehab hospital. (Magee, Philadelphia). One month after discharge I threw away my cane and resumed normal, living alone, pre-op activity. That was 7 years ago at age 85.
No way could I have replaced at home the wonderful work done by the rehab hospital. (Magee, Philadelphia). One month after discharge I threw away my cane and resumed normal, living alone, pre-op activity. That was 7 years ago at age 85.
13
Eight weeks ago I had bilateral knee replacement surgery. Discharged directly home after four days in the hospital. I also live alone, but was fortunate to have old friends come and stay at my apartment with me during the first three weeks. I recovered quickly and could have been alone after the first week, but found I really appreciated the distraction they provided. For me, the first few days home would have been difficult without a friend in the house to help me with meals and to drive me to physical therapy. I agree with the other comments about the difficulties of opiates. I took them for about five days, did not like them, and switched to Advil. Three weeks after my surgery, a family emergency made it necessary for me to fly cross country which I did with no ill effect. By six weeks I was back at work and now exercising completely on my own. I would tell anyone contemplating this surgery to get both knees replaced at once, if possible, because you wake up and it's over - no second operation to anticipate. So, while Ms. Brody's report is very encouraging, I would also suggest to others that if you live alone, try to have a trusted buddy stay with you for at least the first week post discharge. And, echoing other comments here, do all the physical therapy and exercising you can.
7
Had both knees replaced on the same day and recovery was great. Up and walking next day, home 3rd day. Followed all the recommendations both at home and at PT and now have great rotation, no more pain and am very active. I forget I even have new knees. Best thing I ever did.
6
I had hip replacement surgery 2 years ago and now I'm suffering pain in my other hip. I am choosing not to have surgery, opting instead to explore the effects that one leg being longer than the other has had on my physiology. After a podiatrist placed a lift in the short leg I experienced some relief. My fear in having surgery on that hip stems from the fact that my knee on the longer leg has problems including a Bakers cyst. I am afraid the effects of uneven leg lengths lengths might cause the need for knee replacements. The prospect of two hip and two knee replacement worries me as I am only 65 years old and do not look forward to being the bionic woman! Has anyone gotten through surgery with uneven leg lengths and not had all four joints distressed?
8
I am at home now rehabbing from my second hip replacement. I agree with just about everything in this article. However, my experience with the physical therapists who visit with me is that they have good intentions but they always suggest an exercise or a stretch that my surgeon said I should not do. When I tell them this and show them my discharge instructions, they appear to be offended that I want to follow my doctor's PT plan and not theirs. My advice is, defer to your doctor and always be an advocate for yourself, whether at home or in the hospital.
12
Would you want your primary care writing the plan for your orthopedic? Or your contractor planning what your plumber is going to do? In both cases, the people are from the same craft, but they do very different things and I'm sure you would never want that to happen. So why is it okay for your doctor to tell your PT what the plan is? PT's are doctorally prepared, and its important to follow a doctors guideline (i.e. do not flex the hip past 90, avoid active hip abduction for 6 weeks etc) since they did the surgery, but its not for a doctor to decide what specific exercise a patient will do. So yes, it is important to defer to your doctor, but not at the expense of ignoring other qualified health care providers.
6
I had right knee replacement about 4 years ago after several painful years. I am now 77 years old. What seems clear to me from the comments I've read here is that one size doesn't fit all. What one patient finds helpful would not necessarily work for another. A lot depends on the patient's general health, disposition, and attitude. While I am overweight, I'm generally in good health with normal BP, cholesterol, etc. I live alone (if you don't count my cats!) so after 2-3 days in the hospital I stayed with my brother and sister-in-law for a week. This was very helpful, but I found that I was itching to go home. While with relatives I had some in-home therapy. To be honest, I found it incredibly boring. What bothered me more than the pain was the constipation. If I can make some suggestion to future patients, avoid opiates. They cause constipation and can be very additive for some people. Use OTC pain meds where possible. The worst pain is in the first 2 weeks. Also, keep moving. Do exercises that are recommended, or not, but stay active. Walk around, whatever you can manage. For me, what worked once I was home was going back to my routine of housework including dusting, mopping, vacuuming, cleaning up after the cats.The movements involved in doing this work was my exercise. In less than a month I was driving to the supermarket to shop. After a couple of months I was pretty much pain-free and remain so today. I highly recommend the surgery if needed.
11
I had both one hip and one knee replaced (in 2015 at the age of 62) and I live alone. Both times I was home in 2 days with a physical therapist coming to visit a few days a week. I did extremely well (and yes I had some pain) and while apprehensive, my doc said as long as I could make it to the microwave ( yes with a walker for a week or 2) that I would be OK at home and I was!!
5
I am a healthy and fit 65 year old and just had hip surgery 10 days ago and was sent home after 2 days. I was ready to go home. I was on minimal pain killers the first day home and then on Tylenol after that. I had 4 simple exercises to do everyday along with walking every waking hour for 5 min. I had a freezer full of frozen meals and my home was adapted with mobility aids. Lastly I had the help of my husband as caregiver. Everything if going well and I don't think it would be any better if I were in a rehab facility. The initial healing process is essentially the same no matter where you are. The exercises are simple enough for anyone to do and do not really require PT. Before I left hospital I was shown how to get in and out of bed, how to use the toilet, how to walk with a walking aid and how to navigate stairs. The system works well. I think it helps a great deal knowing you are coming home and that you need to be prepared -- it makes a huge difference. Even though I did have my husband to help out, I could have been ok with someone who just came around a few times a day.
5
As an anesthesiologist who has had a partial knee replacement I can agree and disagree. The wiser and most physically fit can navigate off the hospital umbilical cord with relative ease. As you move away from that "ideal" things need to be done with care for both the population statistics ( outcome studies etc) to the personal peculiatities of our neighbors , friends , everyone else enjoying our American experience so as to make it right for as many as possible. There will be people we will meet who actually shouldn't be where they are before a.joint replacement that will not thrive unless we bring the entire village to their door. Sometimes that's a tall order
4
I well remember Ms. Brody's articles on her knees...especially recalling her vivid anecdotal experiences regarding severe pain and that she felt under-medicated at the time. I've been postponing knee replacement having witnessed my mother's two and her painful and awkward recovery from both...one when in her 70's and the other 80's. I have dx's of bone on bone (for years) in a compartment in each knee (femur/patella) and have benefited, (I'm in early 70's) from p/t, better knee tracking, education & kinesthetic whole body awareness, activities and dry needling. (also have significant disc issues). So far so good, but I don't count on it forever.
I live alone, am self sufficient, and would dread coming home right after replacement. Severe pain following most knee replacements is well documented. Given this potential (even with drugs) securely attending to basic ambulation and ADL's on my own seems stress laden and risky.
I'm surprised by the data chosen to support the position and point of view in this article, believing conclusions are overstated and over generalized for a vulnerable demographic. Personally I would prefer to heal in my home, with proper care and support, and do not like the policy implications this article may foreshadow.
I live alone, am self sufficient, and would dread coming home right after replacement. Severe pain following most knee replacements is well documented. Given this potential (even with drugs) securely attending to basic ambulation and ADL's on my own seems stress laden and risky.
I'm surprised by the data chosen to support the position and point of view in this article, believing conclusions are overstated and over generalized for a vulnerable demographic. Personally I would prefer to heal in my home, with proper care and support, and do not like the policy implications this article may foreshadow.
6
I've talked to many people who had knee replacement and post-op PAIN is stressed by every one of them. this article makes light of that in most instances. Maybe the respondents here are otherwise very healthy
4
After three decades of pain, my knee replaced was one of the best things I ever done. Fortunately I had family, friends, children of friends and neighbors there for me. Also, I had a chair lift and elevated the hand rail to a shoulder rail and suspended my martial arts belts from the spokes atop the stairs. I was walking to therapy in a few weeks and my atrophied muscles bulked up and my shoe size changed. I had confidence in the doctor and the hospital along with everyone else. Hope everyone had and soon know the same enjoyment.
5
The list of treatments short of joint replacements of course aren't recommended by the society of orthopedic surgeons. Those folks are in the business of cutting, and their counterparts are in the business of selling artificial joints. I do like the idea of rehabbing at home though.
10
Well, the interesting thing there, is that the other things that they do (injections) are overused considering they aren't recommended. PT,tramadol, and NSAIDs are the lest commonly used. Despite the evidence. So, yes, it's all about the $$
One of my cousins has weak joints by birth. She cannot play tennis or badminton because of her week shoulder joints. She cannot run Marathon because of her weak knees or do leg stretches because of hip joints. Though surgeries were recommended but she avoided them. Through balanced diet and suitable exercises, she is living a healthy life. I sincerely believe that in some cases surgeries can be avoided.
2
I am 72, live alone, and had a left hip replaced in 2015 and a right knee replaced in 2016. I came home afterwards, was off opiate in a few days, drove 7 days after the hip and 9 days after the knee surgery. I did have friends who helped out with a few things, but for the most part, I did everything I normally do with things taking a bit longer, but accomplishing what I needed to get done. My surgeon, from New England Baptist (one of the best in Boston) said that it's better for most people to go home and move round rather than lie in a facility waiting for physical therapy. I'm so glad he felt that way, and will come home again, if/when I need the other knee done. I had a positive attitude, and a can do approach and was back in my office in two weeks after both surgeries. I don't think I'm anything exceptional but we all are different, and certainly, overall physical health can be a determining factor as to whether one goes home or to a facility.
7
I'm a 56 year old active male in good shape who just had a hip replaced this week. After dreading and postponing it for years, for me it has been an incredibly anti-climactic and relatively pain free experience. However, having spent one night in the hospital before being released, which was sufficient, I can't imagine having been sent home the same day. Sounds like an insurance industry idea.
5
I volunteer with a joint replacement program and our hospital sends most patients home 2 days after surgery, but strongly recommends having a coach at home with the patient for the first week, mostly because they'll be on narcotics for several days, at least. None go to a rehab facility unless they have complications or special considerations such as other serious health problems.
3
Having had two hip replacements over the last seven years, the most recent one in December 2016, I can attest to how much the rehab and pre op process has evolved. After the surgery in 2010, they kept me in the hospital for three days before sending me home where I did my rehab with my wife's support and one home visit with a PT. I was up and around in about one month and back to normal in six weeks.
The most recent surgery last December was so carefully orchestrated by my hmo (Kaiser)from pre op to rehab, I was walking the afternoon of the surgery, and was discharged the next day. I had two visits from a highly skilled PT and was almost back to normal in two weeks. People were amazed at how fast I was back on my feet finally pain free.
The only part I don't like about having two artificial hip joints, is that even though I have TSA-Pre, I still have to be "patted" down by an agent after the scanning has been done, what a pain!
Finally the artificial hips have allowed me to walk 18 holes of golf, and last year before my most recent hip replacement I had a glorious week of skiing at Northstar. I missed out on the great winter we had in CA this year, but already have next winters plans in progress. If you have chronic pain in your hip or knee joints and joint replacement is an option, go for it! I am 75 and feel like I still have options, like skiing, hiking, walking tours to Europe, etc.
The most recent surgery last December was so carefully orchestrated by my hmo (Kaiser)from pre op to rehab, I was walking the afternoon of the surgery, and was discharged the next day. I had two visits from a highly skilled PT and was almost back to normal in two weeks. People were amazed at how fast I was back on my feet finally pain free.
The only part I don't like about having two artificial hip joints, is that even though I have TSA-Pre, I still have to be "patted" down by an agent after the scanning has been done, what a pain!
Finally the artificial hips have allowed me to walk 18 holes of golf, and last year before my most recent hip replacement I had a glorious week of skiing at Northstar. I missed out on the great winter we had in CA this year, but already have next winters plans in progress. If you have chronic pain in your hip or knee joints and joint replacement is an option, go for it! I am 75 and feel like I still have options, like skiing, hiking, walking tours to Europe, etc.
8
Let's see, orthopedic surgeons ... aren't these the same specialists who for decades recommended and performed gazillions of knee arthroplasties, a procedure recently discredited as no more effective than conservative treatment (such as physical therapy) -- ? I take these sources' viewpoints with a grain of salt for that reason and also because they see the writing on the wall with regard to funding available for joint replacement. Dollars not spent on inpatient rehab may help keep funding available for the surgery they provide.
4
When my mother was leaving the hospital after a knee replacement, she saw somebody who was on her way in - in a wheelchair - because she was having the replacement redone. "Make sure you do the exercises," said the woman to my mother, "as I didn't, and now I am back in here." My mother did the exercises sedulously, and once again there is no stopping her.
2
I had my right knee replaced in Feb 2016. It did not go well. My surgeon was very keen on the procedure but failed to inform me that both my knee caps were slightly off track and thus might require a more extreme proceedure. Following my initial surgery my knee cap dislocated, and a second surgely was required. Six months later the same thing happened again and I had to have third procedure. It's been 15 months and I still do not have full rotation. I urge anyone considering a knee replacement to get a second or third opinion before undertaking such a life altering proceedure. I'm not sure I'll ever walk normally again, and I completely regret not having multiple opinions before I agreed to this.
4
Here are 2 tips you can take to keep your knee joints healthy and avoid the knife.
1. Weight loss. Your body has been kind enough to match your weight loss, much like an employer offers a 401(k) program — every pound of weight you lose equals four pounds on the knee. So losing just 5 pounds equals 20 pounds of pressure off the knee.
2. Exercise and strengthen your thigh muscles (quadriceps). A recent Australian study showed that patients that had thicker quadriceps muscles developed less pain and cartilage damage with less risk of joint replacement surgery compared to those with smaller quadriceps muscles over four years. Swimming, cycling, and Pilates are among the best non-traumatic knee-strengthening exercises to improve blood flow and build muscle.
1. Weight loss. Your body has been kind enough to match your weight loss, much like an employer offers a 401(k) program — every pound of weight you lose equals four pounds on the knee. So losing just 5 pounds equals 20 pounds of pressure off the knee.
2. Exercise and strengthen your thigh muscles (quadriceps). A recent Australian study showed that patients that had thicker quadriceps muscles developed less pain and cartilage damage with less risk of joint replacement surgery compared to those with smaller quadriceps muscles over four years. Swimming, cycling, and Pilates are among the best non-traumatic knee-strengthening exercises to improve blood flow and build muscle.
7
This is quite an old story and it's too bad it took so long for The Times to latch onto it. The home health industry has been having great success with such in-home therapies for a number of years. Many of the home physical therapy visits are intensive and front-loaded soon after surgery so the patient gets the most benefit. The treatment is on-on-one instead of the ineffective group sessions that often take place in cold, uncaring rehab institutions.
When these revolutionary home therapy programs were shared with the media well over a decade ago, hardly anyone paid attention. Perhaps there would have been more stories -- and more patients helped -- if the programs had carried labels such as "Harvard," "Johns Hopkins" or "Mayo Clinic" instead of the names of lesser-known home health organizations.
It's nice to see The Times finally catch up to what home health clinicians have know for years: that in-home therapy is far superior and more cost-effective than institutional rehab.
When these revolutionary home therapy programs were shared with the media well over a decade ago, hardly anyone paid attention. Perhaps there would have been more stories -- and more patients helped -- if the programs had carried labels such as "Harvard," "Johns Hopkins" or "Mayo Clinic" instead of the names of lesser-known home health organizations.
It's nice to see The Times finally catch up to what home health clinicians have know for years: that in-home therapy is far superior and more cost-effective than institutional rehab.
4
Just imagine this " American Academy of Orthopaedic Surgeons" recommends surgery. My brother had the injections and has golfed daily for the past 3 years with no pain. Why would he want surgery so something a little gel can solve? Ditto any of the 1,000's of people with successful hyaluronic acid treatment. It doesn't work for many people, but if it does, why spend ton's of other people's money for very invasive surgery?
5
Another single small study, given the increasing number of surgeries worldwide, focused in Australia.
Australia has nationwide health coverage; one presumes that the patient's history, other medical problems and social supports are known from the referring "GP","PCP"or whoever is tasked with following the patient. Further, the patients have advance warning of their post-surgical option as well as access to necessary services (without major cost )to the patient. If there are problems in setting up care and a PT, I assume patients without family/family who CAN take leave from their employment/social service can be involved.None of this is available in the US, except for minimal, poorly paid,very limited hour,part-time "help" through Medicare(after 3 consecutive days in hospital) for which we pay 20% of the cost.
Pre-planning is a complete fantasy in the current "health care" system. I am the primary & only caregiver for my spouse, who has major health problems as well as advancing Dementia.I am usually left to care for my spouse after complex discharge orders/meds/etc. are given by health care professionals who are AWARE of the situation. In every event,we were given 2- 3 hours notice to leave. Period. Speaking to doctors involves virtually moving into the hospital; NO-ONE knows when they "might" stop by.
Why are savings only achieved by guidelines that may inconvenience the patient? Highly-paid Orthopedic surgeons make a lot of money on these procedures. Cut prices? Never!
Australia has nationwide health coverage; one presumes that the patient's history, other medical problems and social supports are known from the referring "GP","PCP"or whoever is tasked with following the patient. Further, the patients have advance warning of their post-surgical option as well as access to necessary services (without major cost )to the patient. If there are problems in setting up care and a PT, I assume patients without family/family who CAN take leave from their employment/social service can be involved.None of this is available in the US, except for minimal, poorly paid,very limited hour,part-time "help" through Medicare(after 3 consecutive days in hospital) for which we pay 20% of the cost.
Pre-planning is a complete fantasy in the current "health care" system. I am the primary & only caregiver for my spouse, who has major health problems as well as advancing Dementia.I am usually left to care for my spouse after complex discharge orders/meds/etc. are given by health care professionals who are AWARE of the situation. In every event,we were given 2- 3 hours notice to leave. Period. Speaking to doctors involves virtually moving into the hospital; NO-ONE knows when they "might" stop by.
Why are savings only achieved by guidelines that may inconvenience the patient? Highly-paid Orthopedic surgeons make a lot of money on these procedures. Cut prices? Never!
5
I'm an old lady (85 and counting). I've had both knees replaced, went home, and my son -- who can work at home -- stayed with me. Everything was okay for the 1st knee. It started okay for the 2nd knee until the Home Health Nurse from Hell arrived. Over my objections, she ripped off the bandage (the surgeon is supposed to do that), substituted her own bandage and told me everything was wonderful. Knee got infected. It will never be okay. So - by all means, go home. There's no place like it. BUT - don't let the home health nurse do anything that your surgeon hasn't authorized.
7
Very skeptical that the article never mentions geriatric knee and hip replacements in all of the "data" about how awesome it is to send patients home right after surgery.
Most replacements occur with the elderly and sending them home immediately "even when living alone" is ridiculous and dangerous.
Most replacements occur with the elderly and sending them home immediately "even when living alone" is ridiculous and dangerous.
38
if they are that elderly why spend the money on joint replacement? If they are so handicapped that they can't live on their own why is money being spent on something that they probably can't use and will make no major difference in their life style. I know it is rather callous and each case is it's own story but somewhere we should draw the line on fixing people that will never really use the investment. Everyone I know who had a joint replacement had no problem with rapid healing, in fact way faster than having a torn ACL fixed.
I'm an old hand at replacements: two left knees and both hips. In January of this year, I finally had my right knee replaced. My doctor suggested I have surgery in the morning and go home in the afternoon. I was aghast; at 73 I had lots of concerns. Turns out they were all unfounded. This was my easiest surgery yet. I was thoroughly prepared and being at home following my program was a heat help.
1
This article couldn't be more timely for me. I am having a knee replacement this Monday. I am going home after a 3 day stay in the hospital. I am really nervous about this surgery mostly because of the painful rehab. But as the writer says, I tried steroid shots, non steroid pain killers, but nothing really helped as it is bone on bone now. So this is the last resort. I am in my mid sixties, with no blood pressure, diabetic etc. There has never been a time when I did not work out at least 4 to 5 days a week. But of late, because of my knee pain, I am so inactive that my weight has crept up. I have learned that no amount of calorie control helps without physical activity. I am hoping to return to my long walks and enjoy my grand kids again after I get this surgery and rehab over with.
25
I hope all goes smoothly for you!
24
Had partial knee replacement at surgical center and went home same day. Had someone stay with me the first 24 hours. All went well. My neighbors help keep a eye on me.
1
I've had the bone on bone and had my knee replaced when I was 45. Compared to the pain you live with all the time, the rehab is a cake walk. Make sure you have good circulation boosters for your legs and be aware that cramps in your lower leg should never ever be massaged. It could be a DVT (deep vein thrombosis) Other than that. You are gonna LOVE your new life!!!!
2
Prevention is the key. Maintaining proper weight and exercising as a way of life will avoid this expensive band aid. Don''t be stupid.
7
Not if you play basketball several times a week from age 8 to 55. The knee joint wasn't designed to withstand that kind of impact loading.
My weight has always been within that set forth in aggressive insurance tables. I've also exercised consistently. Had knee surgery at 55.
You might want to rethink that and not be so quick to call people names chief.
My weight has always been within that set forth in aggressive insurance tables. I've also exercised consistently. Had knee surgery at 55.
You might want to rethink that and not be so quick to call people names chief.
24
Why do you assume that anyone needing a knee replacement is fat and out of shape. That is ignorant
20
Oh gee. Another "this is your fault" comment.
My hip broke down due to avascular necrosis. The bone was dead. This was due to radiation that was done to the hip 3 years prior because of metastatic breast cancer.
Expensive bandaid? When it became clear to me that I was going to live, I knew that I wanted to be able to walk.
My hip broke down due to avascular necrosis. The bone was dead. This was due to radiation that was done to the hip 3 years prior because of metastatic breast cancer.
Expensive bandaid? When it became clear to me that I was going to live, I knew that I wanted to be able to walk.
64
I'm 54 years old, jog 2- miles slowly everyday, have no pain, no meds.....how long will my knees last? just-curious
4
Maybe you should ask David Henry. He seems to think he knows everything there is to know.
8
Depends on how stiff they get and how much pain you can tolerate.
I'm 71 years old, run 5 miles every day, 20 miles once a week and a marathon once a year. Have no pain, no meds. No one can tell me how long my knees will last.
3
Had a total knee replacement a year and a half ago. From my experience, here are my recommendations:
1. If you need a new knee, get one. The relief from pain is worth the short-term hurt.
2. Go home and start in-home therapy immediately. The first two weeks are certainly the hardest and most painful. After that, go to out-patient PT and do the exercises diligently. They are not very hard but there a lot of reps.
3. Have a recliner chair. If you don't have one, get one. It was the only place I could sleep.
4. Don't do it in a cold northern winter. Don't take any risk you can avoid. Gravity is your enemy. I was fortunate to do have it done in Florida--no stairs, warm weather, light clothing, all very helpful.
5, In two months, you'll be walking comfortably and enjoying a pain-free knee. However, you'll probably have pain during the night. That takes several more months to subside. In less than a year, you won't remember any of the pain.
6. I don't recommend being alone. Help with food, finding things, and dressing, and just having company, are invaluable.
1. If you need a new knee, get one. The relief from pain is worth the short-term hurt.
2. Go home and start in-home therapy immediately. The first two weeks are certainly the hardest and most painful. After that, go to out-patient PT and do the exercises diligently. They are not very hard but there a lot of reps.
3. Have a recliner chair. If you don't have one, get one. It was the only place I could sleep.
4. Don't do it in a cold northern winter. Don't take any risk you can avoid. Gravity is your enemy. I was fortunate to do have it done in Florida--no stairs, warm weather, light clothing, all very helpful.
5, In two months, you'll be walking comfortably and enjoying a pain-free knee. However, you'll probably have pain during the night. That takes several more months to subside. In less than a year, you won't remember any of the pain.
6. I don't recommend being alone. Help with food, finding things, and dressing, and just having company, are invaluable.
77
I was very surprised to see that this article does not mention rehab after joint replacement at home with home health care. In our area, most patients now bypass inpatient rehab and go home with physical therapy visits andvisiting nursing care for pain and medication management. These patients avoid the issues of facility related infections and can convalesce in the comfort of their own home with professional help. Having a physical therapist and or nurse available in the home also provides support to the family caregiver. Medicare and most insurances pay for home care after joint replacement.
24
I'm a double knee veteran from 2009 at age 53. After NSAID, Synvisc, PT and determination to avoid the surgery, finally gave in. Best thing I ever did. Here's the best way to do it:
1) GO TO PREHAB BEFORE the surgery! Get the exercises and do them religiously, loose weight, give yourself the best chance of the best recovery!
2) If both knees bother you, GET THEM BOTH DONE! it is very difficult to do the therapy properly if the "good " leg is not good!
3) Be super-compliant and push your therapy! You will only recover as well as you are determined to. You should not like your therapist- he/she needs to inflict some discomfort to get the full extension that you want after the surgery and to keep scar tissue from forming. (my roomate-same age, etc. did not have as positive an outcome- and this was the only difference)
4) GO TO INPATIENT REHAB if possible. The concentration on recovery, twice or more daily PT sessions and Occupational Therapy was invaluable.
5) Learn to manage the pain so that you can SLEEP.
6) Most importantly- HAVE A PHYSICAL GOAL that you want to achieve. Mine was to walk around the campus with my daughter as she left for college. Should be something important to you, a few months out, and achievable.
The value of a well supported postoperative period for knee replacements cannot be overestimated!
Hope this helps!
1) GO TO PREHAB BEFORE the surgery! Get the exercises and do them religiously, loose weight, give yourself the best chance of the best recovery!
2) If both knees bother you, GET THEM BOTH DONE! it is very difficult to do the therapy properly if the "good " leg is not good!
3) Be super-compliant and push your therapy! You will only recover as well as you are determined to. You should not like your therapist- he/she needs to inflict some discomfort to get the full extension that you want after the surgery and to keep scar tissue from forming. (my roomate-same age, etc. did not have as positive an outcome- and this was the only difference)
4) GO TO INPATIENT REHAB if possible. The concentration on recovery, twice or more daily PT sessions and Occupational Therapy was invaluable.
5) Learn to manage the pain so that you can SLEEP.
6) Most importantly- HAVE A PHYSICAL GOAL that you want to achieve. Mine was to walk around the campus with my daughter as she left for college. Should be something important to you, a few months out, and achievable.
The value of a well supported postoperative period for knee replacements cannot be overestimated!
Hope this helps!
29
the people I know who have had joint replacement, Hip, knee or both, go back to skiing in less than 6 months, no moguls is the only thing one of the doctors said. Obviously joint replacement is awesome if you need it. So far lucky one ACl a few years ago so far so good.
How is an Australian study relevant in the US? Here, the difference between inpatient rehab and outpatient is one hour of PT twice a day with specialized equipment PLUS walks with the aides vs. half an hour of PT three times a week (if you're lucky) for two weeks (if you're lucky). In addition, it isn't always possible to be alone at first, as older people often aren't initially mobile enough to make even the short trip to the bathroom or the kitchen.
33
The comment "How is an Australian study relevant in the US?" suggests that people who live in Australia are somehow a different species of human compared to the USA. How silly!! We do not have the best medicine in the world, even if we keep fooling ourselves by repeating that silly phrase.
2
As an experienced PT who has worked at several different inpatient rehabs (IPR) and acute care hospitals taking care of these types of patients in my career, I found your choice of research to cite underwhelming and not applicable to the issue you are trying to address. Comparing Australian outcomes to the U.S. is like comparing care from an attending to a med student. Australian physiotherapists have significantly higher pull in their health care system on the level of an MD that I have witnessed firsthand vs in the U.S. we are at the mercy of the length of a doctor's prescription and the # of visits pre-programmed into a patient's insurance plan. If you would like to understand this more, Google "how do I get more PT visits for my patient?" and throw in "g-code" and "kx--modifier" if you'd like to experience the daily headache of a PT doing their normal paperwork. I would expect home-based and outpatient outcomes to be much higher in Australia because they are given a much higher priority status in that system.
Secondly, citing an article that reports adverse events for IPR is highly unrepresentative of that population. If you look up Medicare requirements for IPR, 60-70% of your patients must have neurologic diagnoses (stroke, TBI, SCI, etc) and the rest is a mix of med-surg and ortho - 1 in 8 of my caseload is ortho. You are assuming the adverse outcomes that occur in the highly compromised neurologic population occur in for ortho which is a gross misunderstanding to make
Secondly, citing an article that reports adverse events for IPR is highly unrepresentative of that population. If you look up Medicare requirements for IPR, 60-70% of your patients must have neurologic diagnoses (stroke, TBI, SCI, etc) and the rest is a mix of med-surg and ortho - 1 in 8 of my caseload is ortho. You are assuming the adverse outcomes that occur in the highly compromised neurologic population occur in for ortho which is a gross misunderstanding to make
42
@ Amy E. These are very good points. Thanks for posting. I have a friend that's an Australian PT and she says the same thing - that PTs are highly regarded and have more autonomy in Australia. She currently works in the US, but she finds our health care system challenging.
13
AmyE, as an OT with over 20 years of experience I couldn't agree more!
I don't have expected better from the Times to which I happen to subscribe.
I don't have expected better from the Times to which I happen to subscribe.
2
From the article - "Traditionally, Dr. Parvizi said, patients who live alone, those who have both knees or both hips replaced simultaneously, and those with a serious underlying medical condition are automatically sent to a rehab facility after discharge from the hospital."
As I said in my previous comment, I am an occupational therapist with 16 years of experience in CA and NYC. The quote above from the article is false. Surgeons frequently tell patients before surgery that they'll go to rehab, but case managers and social workers are the ones managing the patient's insurance, not the surgeon. The MD frequently has no idea what the insurance will cover. I've had patients demand acute rehab stays for a single knee or hip replacement when, for the most part, acute rehab isn't an option anymore.
I've had social workers/case managers tell me a patient with a bilateral hip or knee replacement can go directly home. Yes, maybe 1 in 100 can go directly home. The rest need rehab that they'll have to fight the insurance company for.
If the patient is young (40s to 60s) and healthy, yes they can go home. But many are obese, not properly prepared for the surgery, and don't even attend the pre-operative class. They come into the surgery totally unprepared. If MDs want people to go directly home from acute care, then only motivated, healthy patients should be selected for these elective surgeries. Please check with your insurance company to see what will be covered post operatively.
As I said in my previous comment, I am an occupational therapist with 16 years of experience in CA and NYC. The quote above from the article is false. Surgeons frequently tell patients before surgery that they'll go to rehab, but case managers and social workers are the ones managing the patient's insurance, not the surgeon. The MD frequently has no idea what the insurance will cover. I've had patients demand acute rehab stays for a single knee or hip replacement when, for the most part, acute rehab isn't an option anymore.
I've had social workers/case managers tell me a patient with a bilateral hip or knee replacement can go directly home. Yes, maybe 1 in 100 can go directly home. The rest need rehab that they'll have to fight the insurance company for.
If the patient is young (40s to 60s) and healthy, yes they can go home. But many are obese, not properly prepared for the surgery, and don't even attend the pre-operative class. They come into the surgery totally unprepared. If MDs want people to go directly home from acute care, then only motivated, healthy patients should be selected for these elective surgeries. Please check with your insurance company to see what will be covered post operatively.
19
M, absolutely correct.
1
If these patients do not do a strict pre-op program their paid for surgery should be denied without recourse. If not, why throw money down the toilet?
1
What's rehab? I have had 2 knee replacements and 2 spinal fusions. I live alone and received minimal care when I was discharged. Okay, so I got hospital-acquired osteomyelitis after the second fusion and had a nurse come to my home periodically over 6 weeks to make certain I was changing my antibiotic PIC line pump competently. Here in Canada we maintain a stiff upper lip and suck it up. We may be embracing diversity up here, but there's nothing quite like British grit to see you through. (Read sarcasm.)
10
OK, but how are you doing now? I hope well.
I really disliked the tone of this article, mostly because of its fatalistic view that hip or knee replacement is inevitable and almost always successful. It even indicated that people with mobility problems should avoid interventions not favored by surgeons. I do not know if that is true, but comparison with back and neck surgery suggest that the same kind of optimistic view, pushed strongly by the doctors who perform such surgeries, is not even close to reality. This is the type of thing that should be carefully studied by people who have no financial interest in the outcome. Clearly such issues as obesity, activity level, age, type of rehab. etc must impact outcomes and it would be valuable to know what role physical therapy or other non surgical options can play in improving health and mobility. This read more like an ad than a serious consideration of how medical treatment should be evaluated.
19
Hip and knee issues are not like back issues. You can mitigate pain and deterioration with lifestyle changes (physical therapy, weight, etc.), but you can never really fix the structural issues of the joint. I know people who have repaired their ruptured discs with physical therapy, but in knees and hips, cartilage will never come back, osteophytes don't go away. The silver lining is that joint replacement has made such advances that it is nearly always successful. Why would you endure increasing pain that limits your ability to exercise when you can relatively easily fix it? When the success rate for back surgery gets to this point, I think many more people will opt for it.
2
I was 51 when I had my first total hip replacement and 52 at the time of the second surgery. The first surgeon I saw when I was 47 (and already in considerable pain) referred me to a Boston-based orthopedist who was looking for good candidates for PAO (periacetabular osteotomy) surgery. Not the surgery for me (basically, a section of the hip bone is cut and repositioned over the femur; screws are used to hold the newly positioned section in place). I was told then that i was too young for hip replacement surgery and that if I opted against the PAO surgery, I should wait as long as possible to have hip replacement surgery so that I could basically live out my days needing just one surgery on each hip. Nonsense.
Finally went to another surgeon and he in so many words told me to get over myself. This is all in your head, he said. You want pain relief, he asked. Get the surgery. You'll wake up without pain.
Best decisions I made. I hiked 30 miles on a day hike 2 1/2 months after my last surgery. Amazing to not feel pain every day. And every night.
What's the point of waiting to live your life? And waiting while you're in pain. Makes absolutely no sense. If you're in pain and find new and different ways each day to talk yourself out of necessary surgery, get over yourself and get yourself over to an excellent orthopedist. You won't regret it.
Finally went to another surgeon and he in so many words told me to get over myself. This is all in your head, he said. You want pain relief, he asked. Get the surgery. You'll wake up without pain.
Best decisions I made. I hiked 30 miles on a day hike 2 1/2 months after my last surgery. Amazing to not feel pain every day. And every night.
What's the point of waiting to live your life? And waiting while you're in pain. Makes absolutely no sense. If you're in pain and find new and different ways each day to talk yourself out of necessary surgery, get over yourself and get yourself over to an excellent orthopedist. You won't regret it.
25
if your doctor tells you something that you don't want to hear go see another doctor. their opinions on what people can do after surgery are all different. Find yourself one that you agree with verify that he has a good record and use him. They are just doctors not gods.
1
If hip and knee replacements are so successful at relieving osteoarthritis pain (and they are), why is there such reluctance to do perform these procedures on patients < 50 years old? The problem is that even under optimal conditions, revision surgery is often necessary after 15-20 years and such revisions are in most cases not as successful as the initial surgery. While modern prosthetic joints hold up well over time (much better than 10-15 years ago), the supporting bones do not. All artificial bearing surfaces generate microscopic debris particles that activate cells (osteoclasts) that break down bone (particle induced osteolysis). This causes surrounding bone to recede from the prosthesis and become less dense. At the time of revision, the bone is less capable of supporting a replacement prosthetic joint, the surgery is much more difficult, and the failure rate is much higher. In spite of intense research over many years, this problem has not yet been solved. A patient who has a joint replacement at age 48 will likely require revision at age 63-68--an age when most people are still quite active and would poorly tolerate a failed revision. A patient who has a joint replacement at age 65 is likely to be much less active at age 80-85 and may not require revision of a failing prosthetic joint. If you are immobilized by osteoarthritis, joint replacement surgery will provide excellent pain relief for 15-20 years. It is what happens afterword that you have to be careful about.
4
I appreciate the article, but there is 'the other side of the scalpel' perspective. I had my hip replaced and I kept notes from the onset ("Oh, it is just a pulled groin muscle") to my many types of pain treatment (including medical marijuana - legal in WA state) to my prehab regimen which shortened my recovery period, to which month is the worst month to have surgery, to what to do the just before surgery (evacuate, so they don't have to) to how my rehab went to what I bought, what I shouldn't have bought and what I should have bought and about a dozen checklists for before, during and after surgery. I discuss when you can drive, how soon you will discover and even touch upon how soon you can have 'physical relationships' again. Whew... I share my 'what to expect' experience at http://bit.ly/MyHipReplacement thanks :)
11
I suspect that home recovery means burdening unpaid help, particularly spouses. This appears to work for the patient, but what about for the caregiver? I suspect that if the rehabilitation programs were better, the results of rehabilitation would be better. Spouses or friends provide better care, but at cost to them not measured in this study.
19
I am single and have had both hips replaced 9 years apart. In each case, I had friends stay the first few days (3 days max) as requested/suggested by the surgeon. After that, I had people come once a day in the morning to help with the shower and getting dressed for about a week. Friends brought groceries if needed or I went with them to the store with my walker. After less than two weeks, I was walking on my own and driving. Joint replacement really is not a burden on others helping you. Yes, you should also have someone to walk with you every day as that is what integrates the bone. On the second replacement, friends brought a treadmill for me to use on my own. Further, the exercises for the hip actually are not allowed till 6 weeks post surgery. The only exercise is to walk after hip replacement. There is no reason for joint replacement to be a tremendous burden on caregivers or spouses. I have pets and we modified the house to allow the pets to still eat and me to not violate the bending angles for hip replacement.
8
I am an occupational therapist who has practiced for 16 years. I've worked with at least a thousand people who've had knee and hip replacements. Articles like this make me sick. When I first started practicing in 2001, a patient with a hip or knee replacement would receive at least a week of acute rehab (intensive inpatient hospital therapy). Now that same person gets sent directly home after 2 days in the hospital - whether they are ready or not. I've had people who can barely walk being sent directly home. Health care workers like myself bear the brunt of a patient's anger. I cannot tell you how many times I've been yelled at by patients who are being discharged directly home when they're not ready and my hands are tied. No matter what I recommend (usually a short term stay at a skilled nursing facility), what I say doesn't matter. It's all about insurance reimbursement, not what's best for the patient.
With that said, yes, there are about 20-30% of the patients I see who are healthy enough, have the family support and/or financial resources to go home directly. But many are not and they are pushed out of the hospital irregardless of their poor progress (unable to take more than a few steps, unable to get out of bed on their own, etc) and lack of family support. These patients don't know what they're getting into ahead of time and when they wake up from surgery, it's a shock to them how arduous the recovery process is.
Trust me. It's all about the $$$.
With that said, yes, there are about 20-30% of the patients I see who are healthy enough, have the family support and/or financial resources to go home directly. But many are not and they are pushed out of the hospital irregardless of their poor progress (unable to take more than a few steps, unable to get out of bed on their own, etc) and lack of family support. These patients don't know what they're getting into ahead of time and when they wake up from surgery, it's a shock to them how arduous the recovery process is.
Trust me. It's all about the $$$.
105
I am also an occupational therapist and the director of rehabilitation at a skilled nursing facility. I could not agree with you more. Certainly, a younger patient undergoing joint replacement may find success following discharge directly from the hospital. However, in my 20 years of experience, that person is quite atypical. Unfortunately, money is the only factor driving this trend. It has nothing to do with the patients' best interests or wellbeing.
46
M, your comment should be an editor's pick.
15
Great article! Had suffered four agonizing years. My family doctor and high school classmate referred me to a young in the know orthopedic surgeon.
I was astonished to regain my mobility after having both hips replaced. My whole world opened up after that! Had lots of support from my physical therapist.
I was astonished to regain my mobility after having both hips replaced. My whole world opened up after that! Had lots of support from my physical therapist.
7
I can personally say that taking glucosamine (at least 4 grams a day) has made a huge difference in my life (no knee or hip replacements). I had clicking in my knee over 30 years ago, a friend gave me 1 gram glucosamine tablets (he said 8 a day, I reduced to 4 grams) and in 2 days my click was gone. My brother was to have a knee replacement in 1999, taking glucosamine allowed him to walk well for another 15 years. This is just two people with results, anyone else out there to counter the AMA false advertising?
6
It helps some people, Alan, but not others.
For most folks...by the time you consider the pain and misery of surgery....you've been suffering FOR YEARS and have tried glucosamine, injections, physical therapy, exercise, weight loss, etc. and they no longer work (if they ever did).
For most folks...by the time you consider the pain and misery of surgery....you've been suffering FOR YEARS and have tried glucosamine, injections, physical therapy, exercise, weight loss, etc. and they no longer work (if they ever did).
12
At the moment, I am getting by on cortisone injections--this is worth a try. Knee replacement has been recommended by my ortho--but it's a really big deal for someone living alone.
8
Believe me most of us who succumbed to joint replacement surgery tried everything under the sun prior. You don't think anyone with joint problems wouldn't try glucosamine? (and SAM-E, and calcium, and tumeric, etc. etc, ect. The internet is full of miracle cures for everything. However there is zero scientific research results that indicates glucosamine is any help. I'd say your and your brothers' experiences once again proved the validity of the placebo effect.
1
I have many responses to this article but I'll keep it to one:
The article fails to acknowledge that with new Medicare bundles for joint replacements, surgeons receive less reimbursement for those patients who go to a rehab facility (be it acute inpatient or subacute).
The article fails to acknowledge that with new Medicare bundles for joint replacements, surgeons receive less reimbursement for those patients who go to a rehab facility (be it acute inpatient or subacute).
25
That's not true at all. The bundle (usually around $30,000 lump sum) goes to the hospital where the surgery is performed. From there, expenses are subtracted - surgeons fee, implant costs, supplies, anesthesia costs. Whatever is left over the hospital keeps as profit. Rehab costs come out of that pool, so the hospital stands to make less if the rehab costs are high. The surgeon reimbursement for a hip or knee replacement from Medicare is about $1500-1800, and that is a fixed payment amount that does not vary based on how the hospital manages their money.
8
So it's the hospital that gets less for the rehab, not the surgeon. Still, someone is getting less, so there is an obvious financial motive for the hospital not to refer.
1
So the hospital stands to lose if the patients goes to rehab. Interesting.
3
Why no info on shoulder replacement therapy?
3
Because the article is about knee or hip replacement.
2
We live in a rural area with uneven ground. Our house is an old raised Victorian with many stairs. We were fortunate that insurance approved a week of inpatient rehab for both of my husband's knee replacements. The PT started him on stair work 4 days post op. By the time he was released, he was able to climb several flights with full confidence and immediately sent the walker back. He also had six weeks of outpatient PT and was able to make the 40 mile round trip driving himself. Today, at 77, he bikes and walks 10-15 miles a day, and is more active than many of his friend who are 20 years younger. His sister, a professor of PT in L.A., chose the at-home regimen and did not start rehab for several weeks. Though she has full mobility, her recovery was not nearly as impressive as her brother's but they are both satisfied.
10
The careless dismissal of hyaluronic acid injections is of a piece with the general sloppiness of this article. I have been assured by my orthopedic surgeon that my mobility and activity level would be reduced significantly by a knee replacement. Every six months I get a series of 3 injections one week apart. At age 71, I ski, hike, snowshoe, canoe, et. al. and recovery is ongoing and scrutinized by my physician. The notion that a knee replacement is inevitable (or even desirable) is subject to individual circumstances and expectations of outcome.
19
My situation is similar to Jack's. As is the observation on the sloppy dismissal of injections. These have been of great help to me. Let's remember to look at either carefully crafted, replicateable research studies and to consider individual patients as well before dismissing a proven successful treatment option.
And most relevant...who wants surgery...who wants surgeries post op complications,
And most relevant...who wants surgery...who wants surgeries post op complications,
4
My knee was replaced in December 2007. I live in a suburb of Seattle and the surgeon was a superstar who performed about 400 knee replacents a year. I say was because he passed away a few years ago due to some rare genetic disease. There was swelling, but virtually no serious pain. I live with my wife, and had a visit from a physical therapist about 5 or 6 times. I did use an inexpensive walker.
The most painful part of my surgery was caused by a severe thunderstorm the night before I was released from the hospital. Even the hospital had to go on backup power. As a result I came home to no electrical power for 5 days. It was December so the house temperature was 45F, and sunset was about 4PM. We were fortunate to have fireplaces and we employed candles and battery operated radios and flashlights. Our hot water heater is gas powered so we took frequent hot showers. We ate out mostly and enjoyed the warmth of our autos. My advice would be to have the operation in the summer.
The good news was the operation was largely pain free, and going on 10 years, it is the best joint in my body. I have had severe rheumatoid arthritis for 17 years.
Find a good doctor with with a lot of experience, and best of luck.
The most painful part of my surgery was caused by a severe thunderstorm the night before I was released from the hospital. Even the hospital had to go on backup power. As a result I came home to no electrical power for 5 days. It was December so the house temperature was 45F, and sunset was about 4PM. We were fortunate to have fireplaces and we employed candles and battery operated radios and flashlights. Our hot water heater is gas powered so we took frequent hot showers. We ate out mostly and enjoyed the warmth of our autos. My advice would be to have the operation in the summer.
The good news was the operation was largely pain free, and going on 10 years, it is the best joint in my body. I have had severe rheumatoid arthritis for 17 years.
Find a good doctor with with a lot of experience, and best of luck.
11
The other reason to schedule in summer: the greatest misery of my recovery from knee surgery was having to WALK and go up/down stairs in icy, snowy weather (it was December in Ohio!).
Imagine if I had fallen -- torn out stitches -- or re-damaged my knee! or broken the other knee or a hip! OMG!
It was constant fear and just awful. And I was only 56. It must be unbearable for the elderly or frail or anyone alone.
Imagine if I had fallen -- torn out stitches -- or re-damaged my knee! or broken the other knee or a hip! OMG!
It was constant fear and just awful. And I was only 56. It must be unbearable for the elderly or frail or anyone alone.
11
Thanks so much for this information! OTOH, cortisone shots have enabled me to dodge this surgery so far.
3
Another side effect from my knee replacement is my titanium knee sets off the alarm when boarding an airplane, so expect the full monte examination during the boarding procedure.
I had a total hip replacement surgery almost 4 weeks ago, stayed 2 nights in the hospital, and came home to recuperate with the support of my husband, the Visiting Nurse Association and now outpatient Physical Therapy. The VNA was terrific - when we walked in the door Saturday night, the phone was ringing, asking if a Nurse and a Physical Therapist could come for their initial visits the next day (a Sunday !)
Another resource that has been very valuable is the BoneSmart website, which provides excellent articles and recommendations for both hip and knee surgeries. There is a moderated, well-organized forum available also, with input from knowledgeable administrators (one is a nurse) as well as patients, who share their experiences and solutions. Link is: https://bonesmart.org/
Another resource that has been very valuable is the BoneSmart website, which provides excellent articles and recommendations for both hip and knee surgeries. There is a moderated, well-organized forum available also, with input from knowledgeable administrators (one is a nurse) as well as patients, who share their experiences and solutions. Link is: https://bonesmart.org/
12
Thank you for the information, and I am delighted that all is going well!
2
Get as far away from the hospital and any medical facility as quickly as you can after any surgery. The complication from hospital acquired infection is the biggest risk and danger of any surgical procedure.
In rehab, you have a few hours a day for PT and the rest of the time you're just stuck in a medical facility, most likely w/ a roomie. Terrible food and understaffed.
Don't over do the pain pills, the opiates whether real or synthetic are all highly addictive.
In rehab, you have a few hours a day for PT and the rest of the time you're just stuck in a medical facility, most likely w/ a roomie. Terrible food and understaffed.
Don't over do the pain pills, the opiates whether real or synthetic are all highly addictive.
9
What a terrific essay. I got my first taste of what it feels like to be disabled in an “abled” world when I had a knee replacement. I could neither get on nor off the toilet seat without worry. I didn’t take a bath for a month. High hard-to-step-over curbs caused me to panic. Getting up and down my apartment stairs was almost a no-go. We all break our legs, dislocate our shoulders, rupture our spinal disks and stub our toes. We need a world that reflects these facts and puts the remedies into practice, because we all become disabled in the end.
7
My husband has returned from 7 days of inpatient rehab for knee replacement therapy. His OT and PT there gave him the skills he needed to come home to an 1856 row house with lots of stairs. I believe, lousy food regardless, it was the best thing for him because he received therapy 3x daily there and he's not pushing himself to that degree now. At home he's getting 3x weekly outpatient. There is no one-size fits all to post-surgery recovery but insurance cos will cut costs any way they can. If you want in-patient rehab and it can be covered, fight for it.
24
This is horrifying. A person just out of major surgery and in a great deal of pain is to be dumped off at home? With no help? Studies are in and the insurance companies, by whose profit margins we live and die, are reading them with rapacious interest. Yes six months out it might be the same, for those who will survive.
12
Carmine: this happens all the time. I had a relatively minor outpatient procedure some years ago -- breast biopsy -- in a stand-alone ambulatory surgical center. However, it was done under anesthesia.
I was taken to X-ray to have some markers inserted for the surgeon....after which...I was "mislaid". Aides left me in a basement hallway for 5 hours. I missed my surgical slot! and my pain meds had long worn off, leaving me with three 10-inch needles in my chest.
FINALLY, they took me into surgery at 5PM -- last patient of the day. The surgical center was closing and the nurses/staff all going home! so they literally picked me, woozy and half-conscious from anesthesia, and THREW me into the back of my husband's car -- upon which he drove me home. I could not hold my body upright, so every movement of the car threw me this way and that, even onto the floor of the vehicle.
Once home, I could not stand nor walk, so I had to CRAWL on my hands and knees into the house, and then with his help, collapse onto a sofa.
Seriously. I am not kidding. Thank god, I was an otherwise healthy 35 year old at the time. I cannot imagine what happens to people who are ALONE...frail, elderly, demented, or cannot speak for themselves.
I was taken to X-ray to have some markers inserted for the surgeon....after which...I was "mislaid". Aides left me in a basement hallway for 5 hours. I missed my surgical slot! and my pain meds had long worn off, leaving me with three 10-inch needles in my chest.
FINALLY, they took me into surgery at 5PM -- last patient of the day. The surgical center was closing and the nurses/staff all going home! so they literally picked me, woozy and half-conscious from anesthesia, and THREW me into the back of my husband's car -- upon which he drove me home. I could not hold my body upright, so every movement of the car threw me this way and that, even onto the floor of the vehicle.
Once home, I could not stand nor walk, so I had to CRAWL on my hands and knees into the house, and then with his help, collapse onto a sofa.
Seriously. I am not kidding. Thank god, I was an otherwise healthy 35 year old at the time. I cannot imagine what happens to people who are ALONE...frail, elderly, demented, or cannot speak for themselves.
7
There are agencies who have trained people who can be hired to stay with you for a few days if you are otherwise alone. And here in Maine they are not too expensive. For a hip replacement I hired someone to fix simple meals, help me with a bath, take care of my cat, and make sure I didn't get confused with my meds. It was definitely worth it.
4
We have been sending a large percentage of our patients home the same day but we place a "pain ball" and patients avoid narcotics. Have had very good results.
That works well until the big pain medicine wears off and the swelling begins. Lots of swelling often occurs after a full knee replacement and translates usually to serious pain and difficulty in getting around. Getting out of the hospital very soon after surgery is great, but it's not always smooth sailing for a period of time. Some assistance often is needed no matter how prepared you and your house are.
4
Ice therapy is the key to dealing with the swelling..?.and it will also lessen the pain.
2
What about exercise for knee pain?
2
what about it? It doesn't cure osteoarthritis
1
I live in a very rural area and am disabled. When my husband had a triple bypass we were promised OT, PT, and a visiting nurse to help. I was home alone managing his care for two weeks before the OT and PT arrived, and three weeks before the nurse popped in. And these were just "OK, you have a home and someone to take care of you--bye, now!" visits.
If that's the level of care after heart surgery, I wonder what we could expect after knee surgery...
If that's the level of care after heart surgery, I wonder what we could expect after knee surgery...
25
This is an interesting but very overly simplistic article. There is no "one size fits all" about hip or knee replacement surgery and rehabilitation. Both times I spent about a week in rehab before I came home. During that time I was taught how to SAFELY navigate though the daily aspects of my life-getting in and out of bed, going to the bathroom, taking a shower, getting a drink of water etc. Since I was on strong painkillers, I also had to learn how to do all this SAFELY through the haze of Oxycontin. I felt peace of mind (and my family did too) knowing that skilled people were around 24/7 in case I needed help. Coming home was a big adjustment but at least I had had some training and sort of knew what to expect.
30
I wish I’d been able to rehab at home after my knee replacements in 2012 & 2013. But my house has eight stairs up from the street to its main level, and another dozen up to the bedrooms. There would have been no way I could have made it up and down those front stairs to get to daily outpatient PT, without first having had intensive PT twice daily and OT daily at an inpatient rehab facility. After being released, and getting a couple of weeks of semi-daily home PT and nurse visits, I was finally able to handle those stairs and be transported to the PT clinic.
Although the food was awful at the 2012 facility (and I was forced to take my meals in my room), I don’t think I’d have been able to cook for myself within a couple of days post-op. And the facility where I stayed in 2013 had a wonderful dining room and activities, as well as lessons in self-care without endangering the incision and while dealing with still-severe pain (and the effects of the meds necessary to treat it). The only thing that would have been better at home was the timing of my pain meds, which I could have taken as directed rather than be at the mercy of the anti-theft computerized pill-dispensing machinery that stymied even the RNs at times.
But anyone who lives in an apartment in an elevator building, or in a home without stairs for entry, would be better off rehabbing at home. Just wish it had been possible for me.
Although the food was awful at the 2012 facility (and I was forced to take my meals in my room), I don’t think I’d have been able to cook for myself within a couple of days post-op. And the facility where I stayed in 2013 had a wonderful dining room and activities, as well as lessons in self-care without endangering the incision and while dealing with still-severe pain (and the effects of the meds necessary to treat it). The only thing that would have been better at home was the timing of my pain meds, which I could have taken as directed rather than be at the mercy of the anti-theft computerized pill-dispensing machinery that stymied even the RNs at times.
But anyone who lives in an apartment in an elevator building, or in a home without stairs for entry, would be better off rehabbing at home. Just wish it had been possible for me.
10
I'm about to have my left knee replaced. After reading the article I feel it is a crap shoot. I live alone and hope I can just get home as quickly as possible. I have no one to help me and I'm overweight. I guess it will be up to insurance if I get PT and/or a home health aid. I'm not even old enough for medicare so who knows what they'll decide. I'm hoping I can insist I go home. I'll find out.
6
You likely will get a couple visits a week from a physical therapist, but a home health aide? no. Very few insurance companies cover this, and Medicare only in special circumstances. In general, you are on your own for any home health care, and it is very costly -- $22 an hour in the Midwest, probably more in NYC -- which works out to more than $500 a day (or $3500 a week, or 15,000 a month, or $180,000 a year).
5
My husband's surgeon strongly suggested that he rehab at home for his knee replacement surgeries. He had no problems. My sister-in-law (the nurse) thought that was unnecessary and stayed at a hospital for her rehab. She had infections and had to have the knees done again - twice.
6
My mother just had a right knee replacement. She had the surgery on a Tuesday morning and was home for supper on Wednesday. She was up walking on the afternoon of her surgery. The next day, she had two group therapy sessions to practice basic exercises she could do at home. She had two weeks of home health physical therapy. Now she is going to a physical therapy clinic to outpatient sessions--we're half way through that. She's doing great! Her range of motion is better than the doctor or therapists were expecting, and her pain is under control with over the counter meds now. I was nodding in agreement all through the article. Sure, every patient is different. We were very lucky that my mom responded so well to the way this program is done.
16
So no details on the home post-surgery program in Australia. How many visits by whom per week? What die the program consist of? In the AUS you would be lucky to get in-home PT twice a week. And maybe one nurse visit. Unless you have Medicaid or home health care coverage under your health insurance or long term care insurance, you are out of luck.
And yes. Used the link to consult the article; the synopsis lacks detail and the full text is behind a pay wall.
And yes. Used the link to consult the article; the synopsis lacks detail and the full text is behind a pay wall.
8
I don't know, Jane. This is just yet another cost-cutting measure. I haven't had the surgery yet but plan to in the next 3-5 years. I did meet with a surgeon and the first question the doctor asked me is: Do you live alone? When I answered yes, he promised me that I would not go home until I could genuinely function. For those of us who truly live alone, I don't want to depend on friends to fetch & carry for me. The physical rehabilitation can't be 24/7 and it won't cook me dinner either. I want to have the surgery, give myself the time I need to get well and go home able to live my life.
22
I had my knee replaced 2 years ago, spent an extra day in the hospital and went home. I live alone but a family member stayed with me.
I was fine.
After a day or two, I didn't feel that I needed the walker. At certainly didn't need to be in rehab.
The PT came daily, except Sunday, and the Nurse came once a week or so,
Even if you don't have a family member, try a home health aide for a few days - or see if you can hire someone from the community, so you know more about them.
I was fine.
After a day or two, I didn't feel that I needed the walker. At certainly didn't need to be in rehab.
The PT came daily, except Sunday, and the Nurse came once a week or so,
Even if you don't have a family member, try a home health aide for a few days - or see if you can hire someone from the community, so you know more about them.
8
@Q: people here talk as if home health aides are CHEAP. They are NOT -- not licensed, bonded, insured aides.
They are not nurses, nor are they physical therapists (nor housecleaners!) and won't do heavy housework or anything medical. They are only licensed to do things like bathe patients, turn them, help them dress and eat, and very light housework -- emptying a dishwasher -- and light cooking (like making a sandwich or microwaving a Meal on Wheels).
For this you pay $22 in my modest Midwestern area, and likely much more in big cities. Almost no insurance ever covers this, because if you need someone "there all the time", that's $500 a day (or $3500 a week, or $15,000 a month).
Since it is not covered by insurance -- but perhaps your hospital stay IS covered and rehab IS covered -- you are likely far better off staying in rehab for a couple of weeks, until you can function and do basic tasks for yourself.
Everyone's case is different -- people differ in age, overall health, severity of surgery -- two knees or hips are more serious than just one and more incapacitating -- and it makes a VAST difference if you have a healthy spouse or adult child to help (or not!). And if you live in a warm climate or in a one-floor residence.
They are not nurses, nor are they physical therapists (nor housecleaners!) and won't do heavy housework or anything medical. They are only licensed to do things like bathe patients, turn them, help them dress and eat, and very light housework -- emptying a dishwasher -- and light cooking (like making a sandwich or microwaving a Meal on Wheels).
For this you pay $22 in my modest Midwestern area, and likely much more in big cities. Almost no insurance ever covers this, because if you need someone "there all the time", that's $500 a day (or $3500 a week, or $15,000 a month).
Since it is not covered by insurance -- but perhaps your hospital stay IS covered and rehab IS covered -- you are likely far better off staying in rehab for a couple of weeks, until you can function and do basic tasks for yourself.
Everyone's case is different -- people differ in age, overall health, severity of surgery -- two knees or hips are more serious than just one and more incapacitating -- and it makes a VAST difference if you have a healthy spouse or adult child to help (or not!). And if you live in a warm climate or in a one-floor residence.
3
When I had wrist surgery a couple of years ago, I hired a home health aide--through an agency--for $21 per hour. I really didn't need much help, and only paid for 2/12 or 3 hours.
In the case of knee surgery, though I have friends, I would pay for 2-3 days of this sort of care. I was impressed!
It's small money, considering the circumstances.
In the case of knee surgery, though I have friends, I would pay for 2-3 days of this sort of care. I was impressed!
It's small money, considering the circumstances.
2
I had both knees replaced but three years apart. The first at 63 and the second at 66. I had been working with a professional strength trainer prior to both surgeries, but I am overweight. After the first replacement, I couldn't bend the knee more than 46 degrees which meant I could not get into a car. I spent two weeks in a rehabilitation hospital where I received physical therapy twice a day. I continued home therapy and then rehabbed at an outpatient facility. After the second surgery I went straight home because I had nearly 88 degrees bend immediately after surgery. I had someone come to the house three times a week and did the prescribed exercises the other days. Then I did rehab an outpatient facility when I could drive. In the end, I have a better range of motion in the first knee done. I personally think it is because those twice a day sessions with the physical therapy made the difference. No matter how much people do their exercises, I believe that most of us do not push ourselves to the point that a professional would.
17
Not a fully sensible article. It seems the most important part is that each individual situation must be evaluated. Going home is fine IF, rooms and houses accommodate "getting around", having ice machines, having suitable bathrooms and facilities, managing the trip to and from PT and drs. during the first weeks. That must be the deciding factor not the cost. I had a partial knee and did not need rehab. My daughter had a full went home and managed in spite of pain but her house was perfect for that purpose. My Sis in Law lives in a small apartment up lots of stairs and could not have the mobility in the apartment she would need.
16
Agree! and among the MANY things Ms. Brody fails entirely to see -- if you cannot drive, due to lack of being able to bend your knee or manage the pedals with your injured leg -- if you don't live near public transit -- if you can't afford TWO cab rides EACH time -- if you don't have a friend or spouse or adult child to drive you EVERY TIME -- if you are looped on pain meds, and not safe to drive -- then you WILL NOT GET TO PHYSICAL THERAPY and your recovery will be much longer and perhaps not at all.
8
That's an excellent point! A few years ago, I broke my wrist, not such a big deal, but my car was, and is, a stick shift, and I had major difficulty driving. Spent a lot of time in 2nd gear.
3
In order to go straight home after replacement surgery, you really have to look at multiple factors. There is no way my 90 year old mother could have managed at home without my staying with her for a full two weeks after hospital release. That's with PT and OT three times/week and a home health aide. And the only way I could leave after two weeks was because of the home health aide continuing for four weeks longer. Maybe if she'd had the surgery when she was 70 she could have managed. But not at 90.
19
Recently, I've had both a knee and hip replaced due to osteoarthritis. I've also done yoga for 30+ years. In both cases, after I had a surgery date, I exercised daily on the floor on my back up to the day of surgery.
I went home quickly after both surgeries and did simple bed exercises until I recovered enough to do more on a sturdy folding chair and then the mat. I recovered well from both surgeries.
Hip replacement was a snap compared to knee replacement surgery because it called for reshaping more of the tibia than normal. Post-op pain while exercising was intense for a good four weeks.
I don't think there's enough emphasis placed on getting "in shape" for these surgeries. Physical therapy before a big procedure such a knee replacement should be standard, if the individual isn't able to find suitable exercise that can be done consistently without causing much more pain.
Now something needs to be done about post op PT for knee replacement. The widespread practice of forcing the foot toward the buttock to stretch the knee is outright torture. Some recent studies have pointed out it's not necessary and the outcome still is positive if omitted. I didn't know about this standard "therapy" until it was too late.
I went home quickly after both surgeries and did simple bed exercises until I recovered enough to do more on a sturdy folding chair and then the mat. I recovered well from both surgeries.
Hip replacement was a snap compared to knee replacement surgery because it called for reshaping more of the tibia than normal. Post-op pain while exercising was intense for a good four weeks.
I don't think there's enough emphasis placed on getting "in shape" for these surgeries. Physical therapy before a big procedure such a knee replacement should be standard, if the individual isn't able to find suitable exercise that can be done consistently without causing much more pain.
Now something needs to be done about post op PT for knee replacement. The widespread practice of forcing the foot toward the buttock to stretch the knee is outright torture. Some recent studies have pointed out it's not necessary and the outcome still is positive if omitted. I didn't know about this standard "therapy" until it was too late.
21
I had both knees replaced at the same time 4 years ago at age 53, best medical decision I ever made. I live in a split level so I was thankful for an OP rehab facility where I could walk the halls constantly for the week I was there. Therapy was on site and received morning and afternoon. I knew knee replacement was imminent so I maintained leg strength combined with cardio exercise. In my opinion, optimum recovery is dependent on ones health prior to surgery. I know lots of people that have had joint replacement and generally the grossly overweight out of shape candidates do far worse in recovery. This is not meant to be critical but I've witnessed so many people with poor outcomes due to their existing health. Secondary to this is you hope the cutting tools were made to your individual specs and the surgeon is "on" when it's your turn.
13
Glad that it worked out for you, but I would never have both joints replaced at the same time.
4
OK, George..then what's the answer for an overweight, out of shape person whose knees or hips are SHOT and cannot walk without severe pain? And is at risk of falls & injuries?
No surgery? No surgery until they lose 100 lbs (*which would take two full years of constant dieting with no slip-ups or plateauing)? Life in a wheelchair? eventually movement to a Medicaid nursing home?
The POINT is to give that person mobility and the chance to function in society, care for themselves, live a decent life -- stay healthier -- off the public dole -- not to be the "nanny morals police" about who is fat and not worthy of health care.
Do you think an already fat person will get THINNER when they cannot walk by themselves?
No surgery? No surgery until they lose 100 lbs (*which would take two full years of constant dieting with no slip-ups or plateauing)? Life in a wheelchair? eventually movement to a Medicaid nursing home?
The POINT is to give that person mobility and the chance to function in society, care for themselves, live a decent life -- stay healthier -- off the public dole -- not to be the "nanny morals police" about who is fat and not worthy of health care.
Do you think an already fat person will get THINNER when they cannot walk by themselves?
5
Having been involved in this industry (joint replacement & rehab) for several years now, it is expected, at least here on the West Coast, that a reasonably healthy patient getting a single knee or hip replacement, goes directly home. A lesser number of patients getting both hips, both knees, or with particular conditions or frailty that warrant it, do go first to an inpatient rehab, just as you've described with regard to your own procedure.
But unless insurers are happily paying for inpatient rehab (for healthy, single-joint patients) in other parts of the country, I'm not sure how this is news?
But unless insurers are happily paying for inpatient rehab (for healthy, single-joint patients) in other parts of the country, I'm not sure how this is news?
3
David, it depends on a dozen factors -- how old you are, are you on Medicare, how much your insurance covers -- how generally healthy you -- do you live alone, or have a healthy partner to assist you? are you on one floor? or in a multi-story house? an apartment with an elevator or 5 floor walk-up? are you 50 years old -- or 90 years old?
There is no "one size fits all" here.
There is no "one size fits all" here.
1
Total joint arthroplasty is a consequence of the fact that 20th century medical science provided no good solutions for people with mild to moderate joint damage. Basically you had to wait until the damage was severe enough to justify a replacement. The 20th century is over. The modern approach is early to mid-stage intervention with regenerative techniques, such as stem cells. This is not science fiction. There is in fact a wide body of scientific publications on the use of stem cells to reverse joint degeneration. Most of these studies are coming out of Spain and Korea. Anybody who doubts this should do a Google search on "culture expanded bone marrow stem cells for osteoarthritis". I'm aware of 4 separate randomized controlled trials demonstrating the safety and efficacy of this technique. There have been many more published case studies. Unfortunately, our FDA has prevented these treatments from being available in the US. Treatment is available overseas. Uninformed patients in the US will likely continue to believe joint replacement is the only option.
18
The promise of any meaningful and widespread use of stem cell therapy for joints here or other places is many years away. This information also can be looked up.
3
I beg to differ. These treatments have been available for over a decade. Animal studies go back even further. Like I said, not available in the US, but there are clinics in a select few countries that will treat joint injuries and arthritis with culture expanded stem cells. These include Spain, Cayman Islands, Chile, Korea, and believe it or not, Iran.
1
This is why medical tourism exists, and hey, what a great idea!
2
I'm the "designated caregiver" of my elderly parents, both of whom have had knee replacements in the past two years. My dad went to a rehab for 2 weeks, which was a god-send as my mother was recovering from cancer surgery at the same time. My mother, 18 months later, was told that her health insurance would no longer cover a rehab stay.
Not to complain (ok, maybe to complain) but this meant a lot more unpaid work for me in terms of getting prescriptions filled, driving to physical therapy (my dad no longer drives), preparing and serving meals, etc. I feel like this is one more instance of health insurance companies dumping the costs of care onto unpaid family members.
Of course I want to support and help my parents. But it's a challenge to squeeze in as a full-time college faculty member. Subsidized care for even a few days, until she was more mobile, would have made it possible to switch my role from amateur nurse to supportive daughter.
Not to complain (ok, maybe to complain) but this meant a lot more unpaid work for me in terms of getting prescriptions filled, driving to physical therapy (my dad no longer drives), preparing and serving meals, etc. I feel like this is one more instance of health insurance companies dumping the costs of care onto unpaid family members.
Of course I want to support and help my parents. But it's a challenge to squeeze in as a full-time college faculty member. Subsidized care for even a few days, until she was more mobile, would have made it possible to switch my role from amateur nurse to supportive daughter.
26
Martha -- complain as much as you like. I agree completely about dumping more and more responsibility onto unpaid, unprofessional family members.
Interesting article but I think it soft pedals a lot of realities.
My mother, a former RN, had 2 separate hip replacements in her late 70s. Concerned about the risk of infection, she chose to come home instead of go to a rehab facility. She was highly motivated & insisted she could manage her recovery alone. This was not remotely true. During her 1st recovery at home following hip replacement I told my brother after 2 days I couldn't manage doing it with her alone & he moved in. (He went to work part time. When he was there I ate, bathed & slept). Following her 2nd replacement, she came home & my brother & I were both there the entire week.
Her theory as a former RN she could manage her home recovery alone was far from true. She struggled with getting out of bed,
using the toilet, & washing off. She would not have managed without my brother & I there. She had a PT coming over. The first 7 months after the replacements, she fell frequently. I wondered many times if she would have managed walking more successfully with fewer falls if she had spent 2 weeks in a rehab facility rather than trying to learn how to walk herself with a PT visiting about an hour once every 3 days for 2 weeks.
I'm glad my brother & I were there to help but nothing about this recovery was simple, for her children or for a medically trained, healthy, slender, & highly motivated 77/78 year old woman. If & when I need joint replacement, I will go to a rehab facility.
My mother, a former RN, had 2 separate hip replacements in her late 70s. Concerned about the risk of infection, she chose to come home instead of go to a rehab facility. She was highly motivated & insisted she could manage her recovery alone. This was not remotely true. During her 1st recovery at home following hip replacement I told my brother after 2 days I couldn't manage doing it with her alone & he moved in. (He went to work part time. When he was there I ate, bathed & slept). Following her 2nd replacement, she came home & my brother & I were both there the entire week.
Her theory as a former RN she could manage her home recovery alone was far from true. She struggled with getting out of bed,
using the toilet, & washing off. She would not have managed without my brother & I there. She had a PT coming over. The first 7 months after the replacements, she fell frequently. I wondered many times if she would have managed walking more successfully with fewer falls if she had spent 2 weeks in a rehab facility rather than trying to learn how to walk herself with a PT visiting about an hour once every 3 days for 2 weeks.
I'm glad my brother & I were there to help but nothing about this recovery was simple, for her children or for a medically trained, healthy, slender, & highly motivated 77/78 year old woman. If & when I need joint replacement, I will go to a rehab facility.
55
In her late 70s, and technically "alone" (widowed), your mother's Medicare should have paid for several weeks in rehab.
My aunt was in her 80s, when she had this done, and she could have NEVER managed at all -- could not have even gotten into a cab or car to COME home (she would have required an ambulance!) -- could not have bathed, cooked, done laundry. She was in a rehab hospital for about 7 weeks! and it was absolutely necessary. Medicare paid 80% of this.
My aunt was in her 80s, when she had this done, and she could have NEVER managed at all -- could not have even gotten into a cab or car to COME home (she would have required an ambulance!) -- could not have bathed, cooked, done laundry. She was in a rehab hospital for about 7 weeks! and it was absolutely necessary. Medicare paid 80% of this.
3
Thanks, fastfurious!!!
I could not have been able to cope with my husband's first knee replacement if our adult son hadn't been living with us. When he came home from work, I could shower, make dinner and nap. This time, it will just be my husband and me. I'm terrified!
I could not have been able to cope with my husband's first knee replacement if our adult son hadn't been living with us. When he came home from work, I could shower, make dinner and nap. This time, it will just be my husband and me. I'm terrified!
1
Both my knees are bone-on-bone, and have been for, probably, three years. I have made two attempts to schedule knee replacement. The first attempt failed; the second in the process of failing. The reason? I've had three heart attacks, and they're worried I'll go to be with God on the table unless I obtain a cardiac clearance--which my cardiologist(s) steadily refuse to grant. So I'm headed down the road of ever-decreasing mobility; not healthy for the older (I'm 76). My point in this: joint replacement requires, first, good overall health, particularly in the cardiac realm.
12
Get a 2nd opinion from another Cardiology group.
11
Two years ago, I had hip-replacement surgery. I live alone and my home has stairs. I was fine!
I had a mobile toilet downstairs. I walked upstairs, just once a day, using two crouches and going very slowly, to take a shower. It took ages, but I had ages...I had no pain. I stayed on the sofa for an hour, took a round and then laid down again, while binge watching Game of Thrones. So went the first week.
Then I had therapy and while not enough of it, I now know, it was fine. Today, I can walk, run, bend down and otherwise use my hips as always. I waited too long, stupidly, but at 70, I wasn't keen on surgery, which by the way, was while I was awake. I was fine!
I had a mobile toilet downstairs. I walked upstairs, just once a day, using two crouches and going very slowly, to take a shower. It took ages, but I had ages...I had no pain. I stayed on the sofa for an hour, took a round and then laid down again, while binge watching Game of Thrones. So went the first week.
Then I had therapy and while not enough of it, I now know, it was fine. Today, I can walk, run, bend down and otherwise use my hips as always. I waited too long, stupidly, but at 70, I wasn't keen on surgery, which by the way, was while I was awake. I was fine!
20
Very smart to have awake surgery when you can. General anesthesia can have. Several side effects including cognitive issues for those who are older.
10
Thank you, human being.
In fact, the awake surgery was a stroke of genius. I felt just fine when done: without any vomiting or general malaise. I felt absolutely nothing during the surgery. The surgeons were just wonderful and I was well looked after.
The only bad moment came when, after the surgery, the nurses wanted me to walk. So they gave me morphine...which made me so sick that I vomited and then fainted.
In fact, the awake surgery was a stroke of genius. I felt just fine when done: without any vomiting or general malaise. I felt absolutely nothing during the surgery. The surgeons were just wonderful and I was well looked after.
The only bad moment came when, after the surgery, the nurses wanted me to walk. So they gave me morphine...which made me so sick that I vomited and then fainted.
Ah! my kind of life.
My 91 year old mother had a knee replacement in late June of 2016. She was unable to return home due to built environment barriers such as two steep flights of stairs leading to her apartment, macular degeneration in both eyes, and the fact that she lives alone. She had 30 days in an excellent nursing home rehabilitation unit and had an excellent outcome from the surgery. HOWEVER: she had a complication from pain medication while she was in the hospital prior to rehab discharge as well as an episode of delirium when she was first admitted to rehab.
I agree with Concerned Citizen that the results of this study are extremely simplistic, assume that everyone lives on one level and has someone who can be their caregiver throughout the process. This is not the case with many older adults. There are excellent rehabilitation centers in nursing homes throughout the US, and their value should not be ignored.
I agree with Concerned Citizen that the results of this study are extremely simplistic, assume that everyone lives on one level and has someone who can be their caregiver throughout the process. This is not the case with many older adults. There are excellent rehabilitation centers in nursing homes throughout the US, and their value should not be ignored.
21
About costs, there is something I didn't see in the article that is pertinent. In order for Medicare to pay for treatment an in-patient rehab facility, a patient has to have a three day hospital stay immediately preceding. So, not only is there additional costs for the rehab there is an additional day in the hospital.
I had a hip replacement done 18 months ago and went home after two nights in the hospital. My son lives with me and he was able to help with food for the first few days as there is a no bending over rule for a couple of weeks. The only rehab I needed was to walk. I was thrilled to get out of the hospital so quickly as the nurses kept trying to give me meds I didn't want and didn't need. The doctor had prescribed two different opioid medications. I refused to even take the prescriptions with me. Over the counter pain pills worked just fine. My recovery has been amazing. A couple of weeks ago I went to the doctor for a check-up and my hip is so good that I don't even need another follow-up appointment.
I had a hip replacement done 18 months ago and went home after two nights in the hospital. My son lives with me and he was able to help with food for the first few days as there is a no bending over rule for a couple of weeks. The only rehab I needed was to walk. I was thrilled to get out of the hospital so quickly as the nurses kept trying to give me meds I didn't want and didn't need. The doctor had prescribed two different opioid medications. I refused to even take the prescriptions with me. Over the counter pain pills worked just fine. My recovery has been amazing. A couple of weeks ago I went to the doctor for a check-up and my hip is so good that I don't even need another follow-up appointment.
14
Articles such as these always worry me. We are making conclusions based on a study from Australia, a country that undoubtedly has some major differences in its system of medical care. Each patient is unique and poses differing factors and considerations. If people are concerned about abuses, the relevant bodies should set up standards for when people are or are not candidates for joint replacement and in-patient rehab which can guide physicians. But, there will always be special cases.
8
American living in Australia here. I have not had a total knee replacement (yet; it is in the cards in a few years), but I have had a lot of knee issues both here and in the US. Australian health care is really no different than what I experienced in the US. The only difference is who pays. You might have the government health system (Medicare) paying if you have your surgery in a public hospital, but then you will likely be on a waiting list for a while before you get it and you will have less choice, if any, in who your doctor is. If you have private health insurance (very cheap compared to the US, since you could go to the public hospital for "free" if you don't have it), you won't wait and can have the doctor of your choice operate on you, assuming they are in network with your private health insurance, just like in the US. And private health insurance might cover some of the costs of your physiotherapy, if you have paid for PT as part of your cover, but I have found that PT for my knee issues here costs me more out of pocket than what I paid post-insurance in the US. If they discharge you early from hospital, you will likely be entitled to some visiting nurse services. But most other home visits you would have to pay for out of pocket except to the extent that your private health cover (if you have it; many people don't) partially reimbursed you. So not so different from the US except that probably more people have coverage for the initial knee surgery.
I had a total knee replacement on March 30, 2016. I was in the hospital for three days, and I did exactly what they told me to do. I took the pain medicine exactly the way they said to (and no, I am NOT addicted to pain pills), did the exercises exactly the way they said to, and did outpatient PT. I cannot imagine NOT having come home from the hospital. I set up in-home "visiting nurse"-style physical therapy for the first two weeks and then went to outpatient PT. I picked the place closest to my house for outpatient PT.
Because I worked really hard at home in between PT sessions, I was discharged early from PT and now am back playing tennis. I go to the gym on days when I'm not playing tennis and do 45 minutes on the elliptical machine and other exercise on those days.
I cannot believe that I put off this knee replacement for as long as I did. I was in denial, saying that I just needed to find the right knee brace, the right injection, etc. But I am pleased that I did it. I am also happy that I had pain meds for the time when I needed them. And I DID need them. I am not a martyr. I did not abuse them.
Conversely, some of the elderly will find themselves in nursing home-style rehabilitation settings. I think they will be demoralized, as this study intimates. Every effort should be made to send people to their home setting. Thanks for this article. And thanks to the people who did this study.
And my doctor, who did my knee replacement, is a rock star!
Because I worked really hard at home in between PT sessions, I was discharged early from PT and now am back playing tennis. I go to the gym on days when I'm not playing tennis and do 45 minutes on the elliptical machine and other exercise on those days.
I cannot believe that I put off this knee replacement for as long as I did. I was in denial, saying that I just needed to find the right knee brace, the right injection, etc. But I am pleased that I did it. I am also happy that I had pain meds for the time when I needed them. And I DID need them. I am not a martyr. I did not abuse them.
Conversely, some of the elderly will find themselves in nursing home-style rehabilitation settings. I think they will be demoralized, as this study intimates. Every effort should be made to send people to their home setting. Thanks for this article. And thanks to the people who did this study.
And my doctor, who did my knee replacement, is a rock star!
25
I disagree with your penultimate paragraph, Zander1948. There is no one-size magic approach. Your therapy worked for you because certain conditions were met. Not so for everyone. Each case needs evaluation on the factors presented - age, physical condition, home environment, availability of home help, insurance coverage.
4
Please let me know if regular corticosteroid injections worked. As long as these work, I am very hesitant to go with knee replacement.
1
So it must be laziness or "all in my mind" that I chose to have 12 days of rehab after hip replacement. I was able to go to much needed rehab because medicare paid for it. Conclusions like those of this study can be used to justify eliminating this coverage. They are too glib and simplified.
37
God bless Medicare -- which we PAY for, over 40+ years of working -- and which should be the norm, for every American citizen age 0-100.
Medicare is paid for separately than Social Security, which is what you paid for while working. Medicare premiums are deducted from your SS payments.
This article is FAR too simplistic in its assumptions -- it matters a LOT if the patient is older or has a spouse to help out -- has Medicare, hence access to affordable physical therapy -- has a ONE FLOOR house or apartment , and not a multi-level home with steps everywhere.
I did have knee surgery (arthroscopic repair of a meniscus tear) and I was in agony, in my colonial home which has stairs EVERYWHERE. I had to crawl up and down stairs on my hands and butt, as I could not walk down. And I was alone all day while my husband was at work, meaning had I fallen...I would have lain there for as long as 8-9 hours! This thought alone is so terrifying, it keeps people trapped in their bedrooms.
I could barely even manage using the toilet, as I could not bend my knee to sit. I simply cannot imagine how someone with TWO KNEES out of commission could manage this.
And forget about driving....getting groceries or medication or any supplies....walking your dog...collecting mail....even getting out to the CAR in the winter!....just to leave my home, requires six STEPS -- slippery, icy concrete STEPS....to get to the driveway.
And I was about 56 when I had my knee surgery. Imagine if I was 76! and a widow! and lived alone!
The only way this sort of care would be remotely doable, would be if we had a comprehensive system of visiting nurses, who would check on patients daily, and services to provide people with short-term food and medicine delivery. Which is....to laugh.
I did have knee surgery (arthroscopic repair of a meniscus tear) and I was in agony, in my colonial home which has stairs EVERYWHERE. I had to crawl up and down stairs on my hands and butt, as I could not walk down. And I was alone all day while my husband was at work, meaning had I fallen...I would have lain there for as long as 8-9 hours! This thought alone is so terrifying, it keeps people trapped in their bedrooms.
I could barely even manage using the toilet, as I could not bend my knee to sit. I simply cannot imagine how someone with TWO KNEES out of commission could manage this.
And forget about driving....getting groceries or medication or any supplies....walking your dog...collecting mail....even getting out to the CAR in the winter!....just to leave my home, requires six STEPS -- slippery, icy concrete STEPS....to get to the driveway.
And I was about 56 when I had my knee surgery. Imagine if I was 76! and a widow! and lived alone!
The only way this sort of care would be remotely doable, would be if we had a comprehensive system of visiting nurses, who would check on patients daily, and services to provide people with short-term food and medicine delivery. Which is....to laugh.
35
One can sign on for an emergency call pendant to allay the anxiety if one is indeed living alone, or likely to be alone for long periods of time following surgery. The systems are inexpensive and easy to implement and discontinue after even a short time.
1
We got my mother a wrist alarm medical alerts from the California company that founded this concept. She resisted having this service until she slipped in her backyard, broke her elbow, and couldn't get up. The rain started falling harder and night was approaching. Fortunately, a neighbor several houses down the street heard her cries for help. She got the point of the medical alert service.
Having this service allowed her to live at home alone more safely. When she had a serious fall one evening inside her house, she remembered to press the alarm button, and heard the voice of an employee who knew her name and age and address. The company could have passed on the code to a key holder outside her door so the firemen wouldn't have to break a door or window. Although she was in incredible pain (cervical fracture, broken ribs, and coccyx), she wanted her son to come over, not an ambulance. The med alert service called my brother who drove over immediately and determined that she needed an ambulance. He thought she would be bedridden the rest of her life, but she make a remarkable recovery and was walking on her on until the last few days of her life when she stayed in bed.
Having this service allowed her to live at home alone more safely. When she had a serious fall one evening inside her house, she remembered to press the alarm button, and heard the voice of an employee who knew her name and age and address. The company could have passed on the code to a key holder outside her door so the firemen wouldn't have to break a door or window. Although she was in incredible pain (cervical fracture, broken ribs, and coccyx), she wanted her son to come over, not an ambulance. The med alert service called my brother who drove over immediately and determined that she needed an ambulance. He thought she would be bedridden the rest of her life, but she make a remarkable recovery and was walking on her on until the last few days of her life when she stayed in bed.
2
The problem with an emergency call pendant is they are not reliable to indicate to the calling center, that you have fallen.
Cell reception in some areas is questionable.
Cell reception in some areas is questionable.
When I complained of pain during walks, my pcp sent me to an orthopedic surgeon. After X-Rays and an mri he said I needed hip replacements in both hips. It has been 10 years since that diagnosis and although I have pain from bursitis and arthritis I am still walking on the hips I was born with. Most of the time what pain I have eases completely while my dog and I go for our first walk of the day. I would highly recommend that you get a second opinion, especially if your orthopedist s group has just completed a new full service orthopedic center.
11
To continue, my father had bone on bone arthritis in his knees. He was in his mid-80s and in excellent physical and mental health. I suspect he was outside the age range for getting a knee replacement but he would have stopped walking without it and we know that old people tend to decline quickly physically and mentally when they stop moving. He had a knee replacement on the worse of the two knees at Hospital for Special Surgery and then went to Burke for rehab for about a week. He could not tolerate any narcotic type pain meds so was in terrible pain for many days. In rehab, his leg was put in a machine that moved it up and down to move the knee for one hour twice a day which was extremely painful but also essential to the rehab - it would have been impossible to do this at home. He had good family support. I truly cannot imagine him making the excellent recovery that he did without the in-patient rehab. He has now passed 90 years old still in excellent health and physically active. I am convinced he would have deteriorated or died by now without the knee replacement, including the in-patient rehab. So what are we to think of a study and the comments such as these?
18
A married friend of mine, 71 years old, recently had a knee replacement done in Austria, and had the use of the above-mentioned movement machine at home for several weeks, paid by insurance, before going to an in-patient rehab. She said all of this was a great help, and feels back to normal, crediting the early use of the machine.
5
Burke is the best! Also, agree with comments suggesting that type of rehab must be tailored to the needs of each patient.
2
As a beneficiary of a total knee replacement last year, I read this article with interest. But, as I was told, "every case is different," and as can be seen in these comments, people's experiences vary.
In my case, I went from the hospital to my home, having elected to have aides and at-home physical therapy rather than go to a rehab facility. As a private person, I found it very stressful to have strangers coming and going all day long, and having to deal with them in addition to recovering. As I live not far from the highly touted Kessler Institute for Rehabilitation, I will definitely choose to go there if ever I needed another replacement.
I must note that while in the hospital, I was offered pain pills incessantly, even though I told the nurses I was "1 or 2" in pain on a scale of 1 to 10. I took them for a day or two and stopped. I was sent home with a 30-day supply of oxycodone, which I buried in the garbage and sent to the county incinerator. No wonder there is an opioid epidemic.
Last, my relatively quick and easy recovery has been attributed at least in part to my attending physical therapy sessions before as well as after surgery. And I did exactly what I was told to do, which some people seem to overlook.
In my case, I went from the hospital to my home, having elected to have aides and at-home physical therapy rather than go to a rehab facility. As a private person, I found it very stressful to have strangers coming and going all day long, and having to deal with them in addition to recovering. As I live not far from the highly touted Kessler Institute for Rehabilitation, I will definitely choose to go there if ever I needed another replacement.
I must note that while in the hospital, I was offered pain pills incessantly, even though I told the nurses I was "1 or 2" in pain on a scale of 1 to 10. I took them for a day or two and stopped. I was sent home with a 30-day supply of oxycodone, which I buried in the garbage and sent to the county incinerator. No wonder there is an opioid epidemic.
Last, my relatively quick and easy recovery has been attributed at least in part to my attending physical therapy sessions before as well as after surgery. And I did exactly what I was told to do, which some people seem to overlook.
19
I agree about the meds; my knee surgery was some of the worst pain I've ever experienced. But I only needed the Vicodin they gave me for about 5 days -- just to get some sleep -- I hated the way it made me feel, loggy and out of it -- and it gave me awful, scary dreams. After 5 days, I threw the remaining 25 pills away (don't flush it into the water system though!). My prescription had 3 refills, or a 90 day supply!!!
Yes, it is not mystery how people get addicted -- IF you have an addictive personality and you LIKE the sensation of being lethargic and drifty all day. Of course, I realize some poor souls are in tractable pain -- I do NOT mean those with cancer or serious conditions. I mean "ordinary recovery from surgery".
I managed well on a couple of Aleeve every 8 hours for about 3 weeks, then only as needed for pain (occasional). And I am real chicken-livered type, with a VERY VERY low pain threshold.
I myself found physical therapy of dubious value. What helped me recover well was having an active border collie, who demanded 3 walks a day. She saved me! because I had to walk her, and walking healed me.
Yes, it is not mystery how people get addicted -- IF you have an addictive personality and you LIKE the sensation of being lethargic and drifty all day. Of course, I realize some poor souls are in tractable pain -- I do NOT mean those with cancer or serious conditions. I mean "ordinary recovery from surgery".
I managed well on a couple of Aleeve every 8 hours for about 3 weeks, then only as needed for pain (occasional). And I am real chicken-livered type, with a VERY VERY low pain threshold.
I myself found physical therapy of dubious value. What helped me recover well was having an active border collie, who demanded 3 walks a day. She saved me! because I had to walk her, and walking healed me.
7
My husband's experience with the meds has been quite different. at Albany Medical Center, his meds were strictly and carefully doled out, even when he had morphine on day after the surgery. As for what he was prescribed for home, hydrocodon-acetominophen, there are no refills and max 2-weeks use, then on to extra-strength tylenol.
1
Having administered a Joint Program for 10 years now, I can attest to the success for patients going home post joint replacement surgery. This is a practice we have deployed for our patients since 2007. Prior to Bundled Payment program thru CMS, we had nearly 90% of our joint replacement patients going home AND going to out-patient physical therapy directly if they had a driver. The only reason we would entertain anything other (home health, in-patient rehab or SNF) was if there was a safety or patient compliance issue. Our real-time patient satisfaction results we also in the 90% range. With our pre-op joint class and prep and our continuum of care model, patients are well informed about the expectations and are very happy to know they can actually go home and do well.
8
'Sounds so lovely but what you don't recognize is that many elderly people who have those surgeries and live alone were barely hanging on before they had the surgery. This should not be a one size fits all situation. There is a big difference between an elderly person with a full complement of friends and family who can stop by with healthy food and check the ice machine (that helps keep swelling down) and make sure that the patient is doing okay and an isolated older person with even mild dementia who is barely able to keep their head above water in normal circumstances.
23
I agree completely; this article is very naive. It assumes the patient is an otherwise healthy, social, MARRIED person in their 50s or healthy 60s -- otherwise active, in their right mind and with adequate finances. Also that they live in a one level house or apartment with elevator -- they don't even mention STEPS, which are the biggest impediment.
You can take two similar people -- age 60 -- knee surgery -- and one can easily go right home, with their spouse to care for them in a one story ranch house in a warm climate -- the other is all alone, has nobody to help out, and lives in a 3 story house with lots of steps, pets to care for and NOBODY to help -- no money for home health aides or nurses -- and they live in a cold, miserable climate with heavy snow, sleet & ice. TOTALLY DIFFERENT OUTCOMES!!!!
You can take two similar people -- age 60 -- knee surgery -- and one can easily go right home, with their spouse to care for them in a one story ranch house in a warm climate -- the other is all alone, has nobody to help out, and lives in a 3 story house with lots of steps, pets to care for and NOBODY to help -- no money for home health aides or nurses -- and they live in a cold, miserable climate with heavy snow, sleet & ice. TOTALLY DIFFERENT OUTCOMES!!!!
25
The spouse also has to be in fairly good physical condition. Most folks in their '70s have spouses in their '70s. Next time I'll marry a younger man.
Just had my left knee replaced 3 weeks ago, had right one replaced 2 yrs ago. Very glad to have them done so that I can stay active during my senior years. I bicycle most of the time which has helped me stay fit and manage the arthritis for the last 10 years. I definitely appreciated going home after a 2 night stay however both times my pain was not well managed causing me an expensive and painful trip to the ER. What has helped me more than anything in having a successful recovery, is a website called Bonesmart a patient advocacy & Online community https://bonesmart.org
6
Bonesmart is not without controversy. Weigh their advice carefully, particularly about PT for knee replacement. Also wouldn't hurt to google what others think of the site.
3
I've had both hips replaced and revisions to both replacements (replace parts. In one case the cup had to be bolted in). My first replacement, more than 25 years ago, I asked to go home on the 4th day after surgery. That was unusual. on the last few, I left the next day.
The only problem I've had since replacement is a dislocation while working with a personal trainer. The doc who put me back together asked what I had been doing. I said two days/week karate, mountain biking, hiking, and weight training. She said "these hips are designed so you can walk your daughter down the aisle, not to do what you've ben doing."
my bad. I cut out the karate.
The only problem I've had since replacement is a dislocation while working with a personal trainer. The doc who put me back together asked what I had been doing. I said two days/week karate, mountain biking, hiking, and weight training. She said "these hips are designed so you can walk your daughter down the aisle, not to do what you've ben doing."
my bad. I cut out the karate.
15
Could have driven myself home - the "jiffy hip" procedure is fabulous! I live alone in a townhouse with many stairs. After my first hip replacement, for osteonecrosis, I got home about 24 hours after the anesthesia wore off. Never needed the walker, or the cane, or the pain meds. For ten days a home health nurse or PT showed up every three days to make me do exercises and check the small incision. My recovery was so quick my MD cancelled all but the first follow-up. A year later I repeated the process for the other hip. Alternatively, a friend was in the rehab hospital a full month after receiving each of his new knees, though he had a one-storey house and lots of household help. We are about the same age, but he has long been the slim, fit one who swims five miles a day and I'm a fat couch potato. Draw your own conclusions.
5
Everyone is different, kat. I believe strongly that the PATIENT should have final say-so on whether to go home -- if they even CAN do so -- or stay in a rehab hospital. And health insurance should give everyone that CHOICE.
Most people I know who had hip surgery were incapacitated for over a month, unable to even use a toilet let alone walk up steps. You were incredibly lucky.
It is likely that your friend did not have as easy a recovery. Weight is not the only factor here.
Most people I know who had hip surgery were incapacitated for over a month, unable to even use a toilet let alone walk up steps. You were incredibly lucky.
It is likely that your friend did not have as easy a recovery. Weight is not the only factor here.
5
I think the "anterior approach" or "jiffy hip" procedure is the secret. Small incision, quick recovery.
Medicare covered most of my costs; it would have covered a rehab facility only after a 3-day hospitalization; I was willing to go, but a "jiffy hip" is practically an outpatient procedure. Compared to the excruciating pain I was in BEFORE the surgery (when I was also managing all the stairs etc. on my own), the post-op discomfort seemed very minor.
I agree that patients should be able to choose, but it's the insurance companies who have that power. My friend is wealthy and has private "gold standard" insurance.
Medicare covered most of my costs; it would have covered a rehab facility only after a 3-day hospitalization; I was willing to go, but a "jiffy hip" is practically an outpatient procedure. Compared to the excruciating pain I was in BEFORE the surgery (when I was also managing all the stairs etc. on my own), the post-op discomfort seemed very minor.
I agree that patients should be able to choose, but it's the insurance companies who have that power. My friend is wealthy and has private "gold standard" insurance.
2
I read the supporting article. It makes recommendations after knee replacement only. There were no post-hip replacement subjects in the study.
Hip and Knee replacements are two very different surgeries. Recommendations for one group cannot necessarily be generalized to the other group.
It is also important to notice that the study included only subjects who can perform the home exercise program upon leaving the hospital. This would eliminate quite a few patients.
Hip and Knee replacements are two very different surgeries. Recommendations for one group cannot necessarily be generalized to the other group.
It is also important to notice that the study included only subjects who can perform the home exercise program upon leaving the hospital. This would eliminate quite a few patients.
11
Frankly, I don't see how a hip replacement patient could go home alone after just a few days.
A hip replacement is FAR more debilitating and a patient usually can't even use the bathroom and needs a bedpan -- something most family members can't or won't do.
They also need help with all daily activities -- bathing, meal prep, laundry -- unless they have a healthy spouse or adult child in the home -- this is frankly impossible.
A hip replacement is FAR more debilitating and a patient usually can't even use the bathroom and needs a bedpan -- something most family members can't or won't do.
They also need help with all daily activities -- bathing, meal prep, laundry -- unless they have a healthy spouse or adult child in the home -- this is frankly impossible.
9
Not quite the case with my husband. He had his hip replaced 3 years ago at age 59. It was an anterior replacement--that is, the surgeon went in from the front, not cutting through the buttocks--so this greatly lessened the recovery time. He stayed in the hospital overnight (I stayed with him) and we went home the next day. He was given some Vicodin but really didn't need it--prescription Tylenol was enough. A PT came several times a week for several weeks. I stayed home for two weeks to make sure he could manage on his own before I went back to work. He did not ever need a bedpan at home. He was assiduous in doing his PT exercises. We had stairs in our house which he was able to navigate within the first two weeks; slowly, but he could manage.
Aside from the anterior surgical technique used, other reasons my husband recovered so quickly (back at work in a month) was because he was and still is in excellent physical condition, was and is not overweight (putting less stress on his joints), and did his PT exercises faithfully.
I agree that my husband couldn't have managed at home without me; in that case, a stay in a rehab facility would have been in order. However, because of the less-invasive surgical technique and his fitness level, he did not need a full-time caregiver while he recovered.
Aside from the anterior surgical technique used, other reasons my husband recovered so quickly (back at work in a month) was because he was and still is in excellent physical condition, was and is not overweight (putting less stress on his joints), and did his PT exercises faithfully.
I agree that my husband couldn't have managed at home without me; in that case, a stay in a rehab facility would have been in order. However, because of the less-invasive surgical technique and his fitness level, he did not need a full-time caregiver while he recovered.
5
The dark side - infection - is all too often ignored in articles such as this. Acute infection (frequently MRSA or a.baumannii) strikes about 2.4% (50,000) of hip and knee implants in the US annually, requiring removal of the implant in almost all of those cases. After removal, which is a difficult surgery, spacers infused with antibiotics are inserted, an antibiotic drip is infused periodically for several months, after which approximately 80% of these patients get successful re-implantation. The other 20% (10,000) suffer one of several bad options: life without a joint, loss of a limb or death. Wayne D. Bacon, Garwood Medical Devices, LLC
16
This article did mention infection.
I also know a fair number of people -- admittedly almost all over 75, many over 80 -- for whom knee replacement meant that instead of painful knees, they were total cripples confined to a wheelchair or sent to a nursing home instead of living in their own homes.
Not all knee surgery "works". Often it takes something bad and makes it 1000 times worse.
Not all knee surgery "works". Often it takes something bad and makes it 1000 times worse.
6
can mr. bacon be more specific about the 20% who are not able to successfully get new hip replacements. can they get placers again? is there any literature?
I have read Jane Brody for years, but am always frustrated by her tedious report of data. I always feel her findings could be more succinctly stated.
3
Jane Brody has a degree in biochemistry (Cornell) and master's in science writing (University of Wisconsin). As a scientist, she studies the reports and summarizes them to a degree to provide the information establishing her writing is evidence-based, not just anecdotal. She also provides links to allow us to read the extensive studies ourselves and draw our own conclusions. Opinions differ, I know. But I like her attempts to summarize without eliminating all the data.
7
I think her articles are often simplistic and should not be read as the last word. They're interesting but no substitute for real research.
Seven years ago a orthopedic surgeon looked at my xrays and declared that people with knees and hips like mine were already in wheelchairs. I decided that was an invitation to knee and hip replacement and have not been back. I take no medication and I do all my own cooking, shopping and cleaning. Sometimes I have pain, there is a lot of stiffness but nothing a 75 year old woman would not expect from a well used body.
The American Medical system is so profit oriented that people no longer matter. I am going to try and stay far away from it.
The American Medical system is so profit oriented that people no longer matter. I am going to try and stay far away from it.
14
When I first saw an orthopedic surgeon -- at 56 -- I was told "you have some of the worst arthritis I have ever seen!" -- but I didn't go for arthritis. I went because I was attacked by a dog, and dragged, and in that attack, my meniscus cartilage was torn. I had no pain or disability -- nothing worse than any average person my age.
I was told you can have bad looking x-rays, but feel fine -- or be in constant pain and little shows up, even on an MRI. Pain is subjective.
Don't let anyone push you into surgery you do not want or need. If time comes and you NEED a knee or hip replacement....trust me, you'll know it.
I was told you can have bad looking x-rays, but feel fine -- or be in constant pain and little shows up, even on an MRI. Pain is subjective.
Don't let anyone push you into surgery you do not want or need. If time comes and you NEED a knee or hip replacement....trust me, you'll know it.
6
A good majority of the people I know who have had hip replacements are very overweight. Several have had multiple replacements. Wouldn't it be easier and cheaper to just lose 50 pounds?
1
The people I know who have had hip replacements were mostly normal weight. They had the misfortune to have the genes for arthritic hips. And depending when you have your first hip replacement, unfortunately it's normal to need another one as they do wear out. As for it being easier to lose 50 pounds, ask someone who has done it and kept the weight off. I guarantee that they will disagree with your blithe statement. It may be cheaper, but it's not easier--and once the damage has been done to the point where you need a hip replacement, it doesn't repair itself.
4
@Anita: even if true....by the time the patient needs a hip replacement....the joint is totally worn out. Losing weight will not replace the femur head, nor the destroyed cartilage!
That is a cruel and heartless remark. Also: every person I know who required hip surgery was normal weight or slender. (Just anecdotally, of course. I don't know what the stats say.)
That is a cruel and heartless remark. Also: every person I know who required hip surgery was normal weight or slender. (Just anecdotally, of course. I don't know what the stats say.)
5
Please, please, please stop fat-shaming people. Multiple studies have shown that there are literally over 50 causes of obesity. And once the weight is on, studies also show it is incredibly difficult -- in some cases almost impossible -- to take it off.
In any event, no, weight loss will not help many of these people. When arthritis ravages a joint, the cushioning cartilage is gone. The result is bone-on-bone -- excruciatingly painful. I know. I watched my slim, trim, and fit husband grapple with pain on a daily basis, due to arthritis which runs in his family. Now, with a new hip and a new knee, he still has some pain, but very little.
In any event, no, weight loss will not help many of these people. When arthritis ravages a joint, the cushioning cartilage is gone. The result is bone-on-bone -- excruciatingly painful. I know. I watched my slim, trim, and fit husband grapple with pain on a daily basis, due to arthritis which runs in his family. Now, with a new hip and a new knee, he still has some pain, but very little.
5
Yeeesh....both knee and/or hip joints replacements!?! Gaaaa. And I thought getting a tooth implant was a toughie. Heh! I guess I should be grateful for genetics in this case? I'm into my Boomer years with nary a sign of problems of the knee/hip sort. And my 85 year old father still runs marathons on his original set of wheels, too. All with nary a Tylenol in sight. Don't get me wrong I get it. I've more than a few friends suffering such aging maladies. I just presume I must have done something extra special in my last life to warrant the genetic lottery win in this one.
John~
American Net'Zen
John~
American Net'Zen
3
I am lucky to live near Maine Medical Center in Portland, where its orthopedics chief has replaced thousands of hips (including both of mine) using a minimally invasive technique developed in Germany. The joint is replaced without cutting any muscles or tendons; the patient is up and walking the same day and home the next. Extra-Strength Tylenol is primarily what's needed for pain management, and follow-up PT is all done at home.
I live on my own and was able to manage well after both procedures with good preparation beforehand (a supply of frozen meals and some assistive devices), plus helpful friends. Because I live in a city in an elevator building I was able to avoid going stir crazy by going out for short walks and taking taxis to the movies as soon as I could sit comfortably for longer periods - which was pretty soon after surgery. People I know who have had hips replaced with conventional procedures have had very different experiences and longer, more arduous recoveries, requiring a lot of PT. If you're in the market, I'd recommend looking for a surgeon who offers the minimally invasive alternative.
I live on my own and was able to manage well after both procedures with good preparation beforehand (a supply of frozen meals and some assistive devices), plus helpful friends. Because I live in a city in an elevator building I was able to avoid going stir crazy by going out for short walks and taking taxis to the movies as soon as I could sit comfortably for longer periods - which was pretty soon after surgery. People I know who have had hips replaced with conventional procedures have had very different experiences and longer, more arduous recoveries, requiring a lot of PT. If you're in the market, I'd recommend looking for a surgeon who offers the minimally invasive alternative.
12
I am an old rehab md and have taken care of 1000's of post op joint replacements. If the orthopedists don't think inpatient rehab is needed after joint replacement surgery then please stop doing procedures on marginal patients: the overweight, the chronically ill, those without social support, and the mentally ill. If you can't walk or use the bathroom without help after surgery and don't have help well I can't really see how you can go home alone.
The problem is, that many orthopedists show no restraint in who the choose to operate on. Also, the life expectancy after the average joint replacement is not that long. If we want to control costs, individual surgeons should NOT be able to decide who gets a joint replacement. The abuse in this area of medicine is staggering.
The problem is, that many orthopedists show no restraint in who the choose to operate on. Also, the life expectancy after the average joint replacement is not that long. If we want to control costs, individual surgeons should NOT be able to decide who gets a joint replacement. The abuse in this area of medicine is staggering.
113
What do you mean by "marginal?"
1
Inpatient rehab is always an option when the at-home environment is not safe or otherwise unsuitable for the patient.
But when at-home rehab is indicated, it speeds recovery while simultaneously reducing health care costs.
But when at-home rehab is indicated, it speeds recovery while simultaneously reducing health care costs.
3
You have a point. One recent retrospective analysis of roughly 200 patients indicates that about a third were unnecessary: http://onlinelibrary.wiley.com/doi/10.1002/art.38685/abstract;jsessionid... ("Use of a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multicenter Longitudinal Cohort Study"). The problem of unnecessary surgery is hardly confined to orthopedic procedures.
Having said this, the point about home rehab being at least no worse than inpatient rehab--for the vast majority of people--still holds.
Having said this, the point about home rehab being at least no worse than inpatient rehab--for the vast majority of people--still holds.
1
While I will always prefer my home to any institution, when I need care post surgically I want to be care. I've been sent home unable to walk, in uncontrolled pain, and absolutely and obviously unable to care for myself. Medical care in this country is barbaric.
46
That's just awful! You DO need to speak up and TELL your doctor if you are in pain -- or if you have nobody at home to help (they should ask, but often don't!) -- if you don't want to go home, or feel you can't do so safely -- SPEAK UP.
At least for those on Medicare....you are guaranteed a certain number of weeks in rehab after surgery.
At least for those on Medicare....you are guaranteed a certain number of weeks in rehab after surgery.
7
No, you are not guaranteed a certain number of weeks by Medicare. You may be eligible for up to one hundred days in a facility but you have to be admitted to a hospital for at least three days for Medicare rehab facility benefits to kick in. And Medicare (and supplemental policies) are subject to authorizations. If you are deemed well enough to discharge, you are discharged.
5
The hospital my 93-year-old mother was admitted to after her serious fall tried to send her home right after midnight (she had injured herself from a fall in the evening) in order to get two days of pay from Medicare. My brother left her side very late at night and received the post-midnight call to come back to pick her up. He mentioned lawsuit. My mother was allowed to stay the three days to qualify for rehab, but the hospital tried to get creative about dates.
4
Wow, I had no idea some joint replacement patients have to spend days or weeks in the hospital rehab. My surgeon does about half of dozen knee and hip replacements on Wednesday morning, we start rehab in the hospital the same day, and the whole lot of us goes home on Friday. It seemed to work well.
7
I am ending week 6 after a full hip replacement. I went home after 24 hours. Before I left the hospital, I had to show the therapists that I could get in and out of the shower, and use the toilet. I went up and down some stairs, and dressed myself.
Once home, I was glad to have my husband at hand. But had I been on my own I could have managed. Before the surgery I filled the pantry and froze a month's worth of dinners. I moved some furniture and rugs, but did not have a hospital bed or other specialized equipment. I gave up my walker on day 4.
My HMO provided a physical therapist who visited 4 times in two weeks, and by week three I was cleared to drive. On day one after surgery I had better mobility than before. If folks have generally good health and are generally strong enough to live independently, they should be fine on their own.
Once home, I was glad to have my husband at hand. But had I been on my own I could have managed. Before the surgery I filled the pantry and froze a month's worth of dinners. I moved some furniture and rugs, but did not have a hospital bed or other specialized equipment. I gave up my walker on day 4.
My HMO provided a physical therapist who visited 4 times in two weeks, and by week three I was cleared to drive. On day one after surgery I had better mobility than before. If folks have generally good health and are generally strong enough to live independently, they should be fine on their own.
24
You do realize your situation isn't merely a matter of "good health" and strength, and you can't generalize thusly? People have hips installed through different approaches which can mean a tremendous difference in severity of aftermath. A minimally invasive anterior will cut minimal tissue and carry fewer dislocation risks. A old fashioned posterior or posterolateral cuts through a good deal of major muscle, affects many nerves, and is a significant reduction in stability, strength, and safety immediately post-op. People with unforseen complications or inter-surgical mishaps, which often do not reveal themselves until weeks later, can take up to a year to fully heal. So, great for you, but please don't generalize and make those with complicated recoveries feel guilty that they aren't "healthy" by your standards.
9
@soozzie: I am honestly glad you did so well. But everyone is not as lucky as you are.
You don't describe your living situation. Do you live in a warm climate? or did you have your surgery in summer? Makes a big difference! my knee surgery was in late December, in the snowy, slushy, icy Midwest! I was absolutely terrified of falling on the ice, as I could hardly walk for weeks.
Did you live in an apartment or condo -- with an elevator? Or a house with six steps in and out -- a flight of 12 steep steps to the bedrooms -- the only bathroom on the SECOND FLOOR?
You had your husband, and frankly, you don't know you would have deal ALONE. Maybe you could hobble around and microwave a few meals -- but could you go shopping? drive to the drugstore? walk your dog?
People have different lives, different pain levels -- live in different areas -- have different families. (A helpful family, adult children who live nearby, a loving compassionate spouse -- BIG DIFFERENCE.) Even a kindly neighbor or two who bring food or companionship make a HUGE difference.
Your age also matters -- were you 55? or 85? The elderly are often widowed, isolated, and unable to get around. And being alone all day is depressing and frightening. Things like cleaning and pet care can make it chaotic.
Lastly: money matters. Money for cable TV...money for having tasty meals delivered...money for walkers and canes...for physical therapy in home.
You don't describe your living situation. Do you live in a warm climate? or did you have your surgery in summer? Makes a big difference! my knee surgery was in late December, in the snowy, slushy, icy Midwest! I was absolutely terrified of falling on the ice, as I could hardly walk for weeks.
Did you live in an apartment or condo -- with an elevator? Or a house with six steps in and out -- a flight of 12 steep steps to the bedrooms -- the only bathroom on the SECOND FLOOR?
You had your husband, and frankly, you don't know you would have deal ALONE. Maybe you could hobble around and microwave a few meals -- but could you go shopping? drive to the drugstore? walk your dog?
People have different lives, different pain levels -- live in different areas -- have different families. (A helpful family, adult children who live nearby, a loving compassionate spouse -- BIG DIFFERENCE.) Even a kindly neighbor or two who bring food or companionship make a HUGE difference.
Your age also matters -- were you 55? or 85? The elderly are often widowed, isolated, and unable to get around. And being alone all day is depressing and frightening. Things like cleaning and pet care can make it chaotic.
Lastly: money matters. Money for cable TV...money for having tasty meals delivered...money for walkers and canes...for physical therapy in home.
8
I am surprised the article did not mention the Hospital for Special Surgery in NYC, the hospital for the athletes! I had my hip surgery done there and was told I would not be going to a rehab location, but straight home. Their campaign was 0% infection rate! I came home with my husband, lived on the first floor, had the orthopedic Visiting Nurse 3 times a week for 3 weeks. I later followed it up by attending a physical therapy center for 3 weeks! I am so glad I went to HSS ... I am now over 70 and go to the YMCA 5 mornings a week, thanks to HSS!
19
HSS shill post.... The infection rate is 0% because they don't have an emergency room so all the infected people are forced to go to their local community ER and therefore don't count towards the index hospital's infection rate. Also not mentioned is the fact that it's a teaching hospital, so residents with varying levels of experience may be performing most or all of your surgery. Attendings often have two surgeries scheduled simultaneously, which would imply either a superhuman ability to be two places at once, or that someone else is performing one of the procedures. They do however have a great marketing campaign with lots of nice I-95 roadside billboards and television commercials loaded with warm music and pleasant anecdotes.
5
They also succeed where other hospitals don't.
1
I've had total replacements of both knees & my left hip. It may be tempting to hurry home after surgery, but especially for those of us who live alone, it makes more sense to go to a rehab facility. In rehab, one has physical therapy twice a day, six days a week, but at home, one only gets therapy twice a WEEK! More therapy equals a much smoother recovery & faster healing. In addition, a person can concentrate on healing, & not worry about meal preparation, shopping, etc. Even for people who don't live alone, women who go home immediately can end up being thrust too quickly back into their normal routine of caring for home, spouse, elderly parents, & even children, so they never get a chance to fully heal or regain their strength. Note that the surgeons quoted are male, so they assume someone is at home who will really help the patient, not someone who expects care themselves! Be aware that post-surgical patients, who are unsteady on their feet, can & do fall at home., resulting in re-hospitalization & greater costs to Medicare. It's better to be safe in a rehab facility than to rush home too quickly.
86
I'd guess that most orthopedists are men.
Tramadol has recently been re-categorized as similar to opiod narcotics, and should not be used for more than three days.
15
Absolutely! Was going to comment on this also. People are actually vet shopping to get Tramadol for their pets and use or sell it themselves
1
Tramadol is highly addictive. And all the doc's lie about it. VERY painful withdrawal for my 90 year old mom. That got MRSA with new hip.
4
Tramadol is a narcotic!
I was given that instead of NSAID's and even a half a one made me sleepy.
No thanks!
I was given that instead of NSAID's and even a half a one made me sleepy.
No thanks!
2
I have managed 150 joint replacement patients per year for the past 31 years. During that time, only about 10% of patients who had joint replacements were referred to an acute rehabilitation facility (ARF). The other 90% either went home, to a sub acute facility. Recently, stricter utilization controls have made it more difficult to get admitted to an ARF. The studies quoted in this article do not answer the question as to who should be admitted to an ARF. In my experience, patients with higher medical complexity, lower functional status, and less home support, are most safely treated in a ARF. If one considers long term costs from complications, they are also less expensively treated there. For example, patients are anti-coagulated to prevent blood clots. Lung clots are rare but potentially fatal. A medically fragile patient with bleeding or clotting is much safer if in a ARF. Post-opInfections are often related to poor diabetes control. Patients with preoperative indications of poor diabetes control are much better off in a ARF. This can ensure tight glucose control. The cost of an infected joint replacement can easily exceed $50,000.00. To match the more intense and expensive acute rehabilitation experience with the patients who need it is at present the art of medicine, though often controlled by non-clinical insurance administrators. In my experience though, there is a subset of patients who do need and benefit from acute rehabilitation.
59
This article appears to deal only with arthritic joint replacement. How different are the outcomes of different post-surgery treatments if it was caused by an accident? Do the same factors apply?
My father fell on uneven pavement when he was 88, and broke his hip. He lives in Wales, and received a hip replacement 2 days later (the NHS, despite US stories to the contrary, provides care when needed). He was kept in hospital post surgery for some weeks (he has cardiac issues too, and they kept an eye on them) and then sent to a rehab unit in another smaller NHS hospital. He went home after a care plan was in place and the home modifications had been done (hand grips in the bathroom, raised toilets, a handrail on both sides of the staircase, a grab bar by the entrance to the home) and carers came 4x a day for 6 weeks to check on him. He has had no problems since.
This sounds rather different from any of the alternatives in this study, and I'm wondering why.
My father fell on uneven pavement when he was 88, and broke his hip. He lives in Wales, and received a hip replacement 2 days later (the NHS, despite US stories to the contrary, provides care when needed). He was kept in hospital post surgery for some weeks (he has cardiac issues too, and they kept an eye on them) and then sent to a rehab unit in another smaller NHS hospital. He went home after a care plan was in place and the home modifications had been done (hand grips in the bathroom, raised toilets, a handrail on both sides of the staircase, a grab bar by the entrance to the home) and carers came 4x a day for 6 weeks to check on him. He has had no problems since.
This sounds rather different from any of the alternatives in this study, and I'm wondering why.
19
Maybe the fact that your father is 88 and also has cardiac issues. It seems that NHS gave your father optimum care considering his age and health status. The home modifications see to it that he can manage at home on his own. I wish U.S. health care was as consistent and dependable as the NHS!
12
For starters -- even with the most lavish, generous health insurance available in the USA -- there are no "carers" who come 4x a time for 6 weeks. There are no "carers" at all. It simply does not exist in the US system.
Once you live the hospital or rehab, you are ON YOUR OWN for the most part -- sink or swim. If you have a great support system -- spouse, adult kids, money for health aides or nurses -- you may well do just fine.
But if you are poor, alone, isolated -- you are really screwed. You'll end up sitting alone all day, in your messy house (nobody to clean it!) eating frozen dinners until you either get better (by pure accident) or die (and their find your decaying corpse weeks later). Seriously. It's that bad.
Once you live the hospital or rehab, you are ON YOUR OWN for the most part -- sink or swim. If you have a great support system -- spouse, adult kids, money for health aides or nurses -- you may well do just fine.
But if you are poor, alone, isolated -- you are really screwed. You'll end up sitting alone all day, in your messy house (nobody to clean it!) eating frozen dinners until you either get better (by pure accident) or die (and their find your decaying corpse weeks later). Seriously. It's that bad.
13
The U.S. healthcare system is motivated by profit. The British system of NHS is not - it's about caring for patients. I live in the U.S. but spent many school terms in England in middle age and my friends and I there received outstanding care for a number of different problems while living in the U.K., free of charge - some of us were not able to get health insurance in the U.S. and the care we received while living in England was an enormous privilege for us. I never had to pay a penny for my healthcare in the U.K. while I regularly spent over $10,000 a year out of pocket for routine health care in the U.S. in those years.
Anyone opposed to government administered national health insurance who opposes adopting such a system in the U.S. has no idea what they're talking about. The U.K. National Health Service is extraordinary and beats any healthcare I've ever had in the U.S., including the years when I had coverage under the much lauded Federal Government plan in the U.S. which covers members of Congress. Americans have no clue how rotten our system is compared to national plans in the U.K. and Europe.
Anyone opposed to government administered national health insurance who opposes adopting such a system in the U.S. has no idea what they're talking about. The U.K. National Health Service is extraordinary and beats any healthcare I've ever had in the U.S., including the years when I had coverage under the much lauded Federal Government plan in the U.S. which covers members of Congress. Americans have no clue how rotten our system is compared to national plans in the U.K. and Europe.
16
I had bilateral knee replacement five years ago and was sent to inpatient rehab. I cannot imagine recovering as well as I did without their help. I couldn't stand when I left the hospital and by the time I left rehab, after a week, I could walk, unaided, without a cane. I never truly understood the value of rehabilitation until I experienced it, and it gave me a full and successful recovery. It was very difficult, even after I went home, but for the wonderful care and therapy I received as an in patient, I have full function.
I NEVER would have pushed myself the way they pushed me at the Spaulding Rehab, Boston, MA. I thank them ;-)
I NEVER would have pushed myself the way they pushed me at the Spaulding Rehab, Boston, MA. I thank them ;-)
47
When asked, patients clearly state their preference to recover at home, and not just from hip and knee surgery, but from most acute illnesses, injuries, or surgical interventions. The good news is that digital health technology is evolving to help with this patient-centered democratization and decentralization of healthcare. Telemedicine and AI-based solutions are allowing patients and their caregivers to feel supported while recovering at home. Population-health based approaches are allowing busy clinicians to quickly 'look-in' on patients recovering at home to see who needs an office visit or more intensive care. Its well past time that we give patients what they want - and it turns out its less expensive with equal or better outcomes!
9
Patients may want to go home, but they don't always know what is good for them. Telemedicine and AI can't replace someone exerting enough pressure on your knee to the point where you are crying----ultimately giving you almost full range of motion. But then, I haven't seen the studies of their ultimate recovery--just my own opinion based on my experience.
11
I would prefer to go home - definitely.
That said, too bad no one can do total back replacement for my knees & hips are fine...
That said, too bad no one can do total back replacement for my knees & hips are fine...
4
My health insurance would only cover three home PT visits a week and one homer RN visit a week after my knee surgery. As my wife was disabled at that time, and unable to help in the post-op recovery, it would cover a two-week stay in a rehab facility.
Having both PT and OT each day for two weeks - plus care assistants who were willing to help me ambulate between the sessions - gave me an excellent recovery.
If daily PT and more than once a week home nursing had been covered, recovery at home would have been possible.
The problem with this approach is that health insurers are too quick to cut inpatient rehab without increasing coverage for home PT, OT and RN visits. What works in Australia with their national health insurance might go horrible wrong if implemented here.
Having both PT and OT each day for two weeks - plus care assistants who were willing to help me ambulate between the sessions - gave me an excellent recovery.
If daily PT and more than once a week home nursing had been covered, recovery at home would have been possible.
The problem with this approach is that health insurers are too quick to cut inpatient rehab without increasing coverage for home PT, OT and RN visits. What works in Australia with their national health insurance might go horrible wrong if implemented here.
37
Kinda like when they closed all the mental hospitals in favor of community care and then didn't provide any community care. That worked ou well, didn't it?
1
My OS would agree. I've just been told my other hip needs replacing but the wait time is now reduced because the standard hospital stay here for healthy patients is 1 night as opposed to 2. "Joint replacement patients aren't sick" and he reasons the sooner patients can be sent away from unhealthy places like hospitals to their own homes the lower the risk of infection and clotting. Rehab begins at home.
15
This article has the outdated, yet still popularly repeated view that joints "wear out" like mechanical parts (which leads to the conclusion that joint replacement is probably inevitable for pretty much everyone.) The more current view of osteoarthritis is that it is a complex process driven by chronic low-grade inflammation (similar to other age-associated conditions like atherosclerosis, Alzheimer's, and macular degeneration.) It would be nice if discussions of this topic didn't keep trotting out the old and misleading "we are outliving our joints" line -- while surgeons aggressively market joint-replacement procedures to younger and younger patients.
85
So we just send them home instead of requiring rehab facilities to do a proper job and PREVENT infections etc? Really?
At age 73, I know a LOT of folks who have had knee or hip surgery. I know of only one who went directly home as she was convinced her family was putting her in a nursing home to die. She did NOT do her exercises and her operation was a total failure due to that.
All rehab facilities are not created equal. A placid, patient who dislikes confrontation, will go where she's told and where there is a bed. That is NOT a good idea and may well cause what happened to a good friend - a serious infection that the rehab facility refused to acknowledge and was only treated when the patient finally called her own doctor. Inexcusable.
I have a daughter nearby but she has a very demanding job and a family and I would never ask her to take two weeks vacation to stay with me and help me. That is why I have Medicare and Tricare. The cost of hiring 24/7 home health care aids would be prohibitive.
In Australia, cost is everything. I was once on a bronchiectasis forum. Pulmonologisst there are not allowed by the gov't to even tell patients about the use of a percussion vest and the gov't will not pay for one. They are to find family members and friends to do manual percussion twice daily for life. Sure - I'll just do that! I do not trust ANY study that comes out of a country with cost being the first priority.
At age 73, I know a LOT of folks who have had knee or hip surgery. I know of only one who went directly home as she was convinced her family was putting her in a nursing home to die. She did NOT do her exercises and her operation was a total failure due to that.
All rehab facilities are not created equal. A placid, patient who dislikes confrontation, will go where she's told and where there is a bed. That is NOT a good idea and may well cause what happened to a good friend - a serious infection that the rehab facility refused to acknowledge and was only treated when the patient finally called her own doctor. Inexcusable.
I have a daughter nearby but she has a very demanding job and a family and I would never ask her to take two weeks vacation to stay with me and help me. That is why I have Medicare and Tricare. The cost of hiring 24/7 home health care aids would be prohibitive.
In Australia, cost is everything. I was once on a bronchiectasis forum. Pulmonologisst there are not allowed by the gov't to even tell patients about the use of a percussion vest and the gov't will not pay for one. They are to find family members and friends to do manual percussion twice daily for life. Sure - I'll just do that! I do not trust ANY study that comes out of a country with cost being the first priority.
27
Well...the problem is you can't have it both ways. Either you have our vastly wasteful system -- that denies care to many and costs $$$$$ -- but which is cutting edge, advanced, and offers those who CAN pay the very latest technologies -- OR you have a more generous social safety net, but one that can only exist by rationing care and deciding to forego cutting edge procedures that cost too much.
No system is perfect, and PEOPLE are all so individual -- what works brilliantly for one person, is a disaster for another person.
No system is perfect, and PEOPLE are all so individual -- what works brilliantly for one person, is a disaster for another person.
5
My mother and I each had a knee replaced. I was 59 and lived with my husband. She was 89 and lived alone. Due to complications, I was in the hospital for 6 days and at rehab for 12 days. I was in pain for well over 6 months. My mother who lives alone, went home alone after 3 days and was fine. Each patient is unique and age is not necessarily a factor.
90
People are INDIVIDUALS. Each case is different -- each situation is different. Hips deteriorate in different ways, for different people. Also surgeons all differ -- some are better than others. Some people heal better than other people.
While having a spouse and being younger are generally advantages...in your case, not so much. Perhaps you had some complications or just don't heal well.
It is false, as Ms. Brody always seems to think, that everyone will have the same outcomes and same results, if they just do the same things.
While having a spouse and being younger are generally advantages...in your case, not so much. Perhaps you had some complications or just don't heal well.
It is false, as Ms. Brody always seems to think, that everyone will have the same outcomes and same results, if they just do the same things.
8
I wonder whether the results of the study on people who live alone would be the same in, let's say, NYC, where more people have to deal with stairs just to get in and out of their homes.
45
A proper hip or knee replacement includes in-hospital PT that focuses especially on stairs, and a patient who's discharged, wherever she is going, will be able to walk up at least a few stairs. I walked up 4 steps to my apartment foyer and another 10 to the raised lobby, slowly yes but so what? Then the in-home therapist arrives and stair walking becomes a big part of the rehab.
4
Gee, how about some sympathy for non NYCers who might more likely have stairs in their house, and not have a kitchen and bath on the same level.
9
While a walkup apartment could be a disaster....I live in the Midwest, in a typical colonial -- an older home, with an attic and basement -- hence, THREE flights of 12 stairs inside the home. Laundry is in the BASEMENT. My office is in the ATTIC. The only full bathroom is on the SECOND FLOOR.
Just to enter and leave the house itself, on the outside, requires six steps -- which in winter, are icy and dangerous.
The garage is not attached, and it requires going down all those stairs, outside, MORE stairs and then across the driveway (also slippery and dangerous).
I call it "ultra-handicapped IN-accessible", lol. When I was a young woman, it was nothing to traverse -- as I got older, and had surgeries, I could see how miserable it could be. When I had knee surgery, I was trapped -- a virtual prisoner in my own home -- thankfully I was married! -- I can't IMAGINE doing this all alone. I went downstairs in the morning and back up at night -- anymore was unthinkable. Just having to pee was a nightmare, as I could not bend my leg to sit down!
Cleaning, laundry, shopping -- all impossible. The level of delivery services that New Yorkers are used to -- where meals, DVDs, dry cleaning, groceries -- can all easily be delivered right to your door -- DOES NOT EXIST in most of the US. If you can get around, you are literally TRAPPED in your home.
Just to enter and leave the house itself, on the outside, requires six steps -- which in winter, are icy and dangerous.
The garage is not attached, and it requires going down all those stairs, outside, MORE stairs and then across the driveway (also slippery and dangerous).
I call it "ultra-handicapped IN-accessible", lol. When I was a young woman, it was nothing to traverse -- as I got older, and had surgeries, I could see how miserable it could be. When I had knee surgery, I was trapped -- a virtual prisoner in my own home -- thankfully I was married! -- I can't IMAGINE doing this all alone. I went downstairs in the morning and back up at night -- anymore was unthinkable. Just having to pee was a nightmare, as I could not bend my leg to sit down!
Cleaning, laundry, shopping -- all impossible. The level of delivery services that New Yorkers are used to -- where meals, DVDs, dry cleaning, groceries -- can all easily be delivered right to your door -- DOES NOT EXIST in most of the US. If you can get around, you are literally TRAPPED in your home.
9
Artificial joints are becoming more durable, but with the age of patients receiving replacements plummeting, it is well worth it to put off joint replacement surgery, since many risk the need for a second replacement before they die.
As Jane points out, no one should be using unproven methods or be forced to endure chronic pain and disability, but I think she gives short shrift in this article to putting off the surgery. One thing she is silent on is weight loss, which works very well to decrease pain and disability.
As Jane points out, no one should be using unproven methods or be forced to endure chronic pain and disability, but I think she gives short shrift in this article to putting off the surgery. One thing she is silent on is weight loss, which works very well to decrease pain and disability.
16
Weight loss is often very helpful before the knee joint becomes badly damaged. But once the damage is done, although losing weight will lessen the pressure on the joint, there will still be pain because weight loss doesn't rebuild bone that has already been destroyed. And bear in mind that if the person's mobility is limited because it hurts to walk, it's harder to lose weight.
35
But what if you are NOT overweight? what if your injuries come from doing running or other pounding, stressful repetitive sports?
What if your injury comes from an ACCIDENT? I needed knee surgery after an ACCIDENT. I was not overweight!
I wish Ms. Brody or SOMEONE would do an article on "why we hate fat people so much, we blame them for literally EVERYTHING".
What if your injury comes from an ACCIDENT? I needed knee surgery after an ACCIDENT. I was not overweight!
I wish Ms. Brody or SOMEONE would do an article on "why we hate fat people so much, we blame them for literally EVERYTHING".
6
After the total joint replacement of my left knee, I opted for what was termed a "rapid recovery" program recommended by my surgeon. I am incredibly grateful that my health insurance (an individual plan since I was under the age to qualify for Medicare) covered my stay. After a short hospital stay, I went to a facility where my PT sessions were a short distance from my room with all the very expensive professional equipment that contributed to a fast recovery as well as trained staff to monitor its correct use. My personal care needs were covered 24/7 by trained people who in the initial stages helped me use the necessary tools to be safe during excursions to the bathroom when I was still using pain medication.
The six month results of using a rehab facility and going directly home may be approximately the same, but the stress on mind and body of leaving the hospital alone or in the care of a spouse or friend for the first week of a joint replacement is considerable. I am certain that my recovery was faster and I am stronger today because my joint replacement surgery was followed by a stay at a rehab facility with swift, consistent physical therapy which cannot be done at home.
Sometimes the intense focus on controlling costs means a blindness to the results that best practices with an initial higher cost can deliver. Future studies which include the real risks and costs of in-home care vs at least the first week at a "best practice" rehab facility are warranted.
The six month results of using a rehab facility and going directly home may be approximately the same, but the stress on mind and body of leaving the hospital alone or in the care of a spouse or friend for the first week of a joint replacement is considerable. I am certain that my recovery was faster and I am stronger today because my joint replacement surgery was followed by a stay at a rehab facility with swift, consistent physical therapy which cannot be done at home.
Sometimes the intense focus on controlling costs means a blindness to the results that best practices with an initial higher cost can deliver. Future studies which include the real risks and costs of in-home care vs at least the first week at a "best practice" rehab facility are warranted.
70
Unfortunately, I think orthopedic surgeons are too quick to recommend knee or hip replacement surgery as a panacea. Let's face it, such surgeries are a big money maker for the orthopedic surgeons. As a 67 year old who has been running for more than half my life, I began suffering left knee pain last year. It was well controlled with ibuprofen, but I'm not a fan of long term NSAIDs use. After reading some articles regarding muscle imbalance, I started doing exercises to strengthen quadriceps and also my low back. After a fairly short period of time, I no longer have pain with running and am no longer using NSAIDs. While I was motivated to fix my knee pain just using exercise, I think it's too easy for surgeons to "push" their patients to joint replacement surgery without aggressively recommending nonsurgical means.
41
I would respond to your comment that you had success with a proven modality, physical therapy, and a responsible surgeon should manage expectations, it is truly not a panacea, but it is the best method for alleviating the pain of arthritis when other interventions have failed. Only a patient knows when they're ready for arthroplasty.
10
Did you have cartilage left around the knee? If not, no amount of strengthening exercises would have fixed it.
12
For joints with no cartilage left, exercising other parts of the body is not ever going to help. A simple X-ray will confirm that. I suspect that you will eventually have to have a replacement, when your cartilage wears away to nothing. You're on borrowed time right now. How do I know this? Been there.
17
I imagine that if a person, who was in good health prior to the procedure, returned to a home where everything is all on one level, and had access to intensive, stay-in-the-home support people if needed, home recovery would be preferable. I look at the 6 steps to get up to the door of my home, and the 12 steps up or down to the nearest toilet, and wonder how I would make it for the first week. Having a hospital bed and portable commode in one of the three rooms on the first floor seems depressing and unmanageable.
41
Had a hip replacement and went home after about 30 hours. Even though we have a bathroom on the main floor, I also had a hospital bed and commode. The hospital bed cost $200 to rent for a month, I used it for about two weeks. Advantages are that the height can be adjusted to let you easily get in and out of bed, the rails help stabilize you when you stand up and the slope can be adjusted to let you sit up and put your knees up easily during the day. The people who delivered it and took it away were great. It was in the way, but made it much easier to sleep and rest during the day. The commode was very useful for the middle of the night. I was so glad to be out of the hospital and at home, where I could sleep and rest and eat food I liked. The devices were helpful and I didn't need them for very long. The reduction of pain from having the surgery has been life changing, don't sweat the little stuff.
33
The next health insurance debacle: after sending women home hours after giving birth because it was cheaper (but not always the right thing to do), now we'll send patients home after major surgery even if they don't have all the supports in place that they'll need.
Not everyone has neighbors and friends who can help out. Some of us do not have the money or the insurance coverage to have in home help. Why is it that lowering costs always seems to involve inconveniencing the patients rather than improving the quality of care offered, the lowering of medical mishaps, or improving the conditions of the facility the patient is in?
Not everyone has neighbors and friends who can help out. Some of us do not have the money or the insurance coverage to have in home help. Why is it that lowering costs always seems to involve inconveniencing the patients rather than improving the quality of care offered, the lowering of medical mishaps, or improving the conditions of the facility the patient is in?
161
I like going home 24 hours after delivery. My babies were in good shape and I had a normal delivery. It was so much nicer being at home than in the hospital. For my last baby the hospital decreed we must stay for two days. I thought it was a waste of money and I was ready to leave. That was all many, many years ago now.
5
It may have worked for you but what about others for whom it doesn't work? You are not the only woman giving birth.
7
I had both hips replaced, six months apart. I went home after a one night stay in the hospital. I live alone. I was able to get around fine once home. In fact one day after returning home i met a friend at a nearby restaurant to which I walked without any supporting device. One week after surgery i drove 200 miles to get my large dog back (who requires four or more walks per day). Very clear to me that i would never have recovered so quickly had i been forced to be in the hospital or in a rehab center. I believe with newer hip replacement devices and surgical techniques, my experience is the norm for those who do not have other serious health issues.
2
While I realize the risk of infection is much more likely in a hospital or rehab facility, I am very skeptical of the assertion that with enough advance planning, even patients who live alone will do better recovering at home. I just took care of a close friend through a total knee replacement. After being discharged from the hospital, he went to an outpatient rehab facility for 8 days, where he had two sessions per day of hour-long rigorous physical therapy. True, visits from physical therapists could be scheduled to occur at home, but there are other considerations. The difficulty in getting out of bed for food and bathroom needs would require a friend or family member to be there for almost 24/7, for the first several days after discharge from hospital. Then there's the administration of the pain medicine, which should not be overdone for obvious reasons. Yet if too little pain med is given, it is simply too painful to do the PT exercises. And the pain Rx needs to be taken 45 min before physical therapist arrives, which pretty much requires a caretaker at home - the patient likely won't feel alert enough to remember to take the pain pills 45 min. before the physical therapist's arrival at the home (and the PT must visit twice daily). If the PT exercises are not done twice a day, the recovery time will be much longer, meaning the patient will have pain and need to use a cane to walk for a longer period of time.
115
I want to double recommend this, because it paints a full picture of what "at home" care actually requires. I had a small outpatient surgical procedure in January, and thank goodness, a friend insisted I stay w/her for a couple of days, because while I could have handled it alone, having mentally alert supervision and care kept me safe and secure.
41
I can not speak to your experience with your friends recovery at home, however in most if not all cases an individual that does not have supportive family assistance is assigned to a PA who assist the patient with ADL's. So what you described is typically covered by the payer. While the payer may may assumptions in reviewing the case and deciding against home services it is the provider and the hospital case worker that develop the DC plan and prescribe home services.
7
Another issue - and this applies, I think, to any surgery where general anesthesia was used, i.e. not just knee replacement - is that the recovering patient needs to use the spirometer many times per day (to reduce the risk of fluid building up in the lungs) and also needs to move their legs often to help the circulation and reduce the risk of blood clots. These things won't happen if the patient is alone too much. Admittedly, putting the patient in a rehab facility may be less effective in these areas than having a devoted family member or friend at home.
9
An alternative to hip joint replacement is hip resurfacing orthoplasty. It has several advantages over replacement, but a well-trained surgeon is vital:
https://en.wikipedia.org/wiki/Hip_resurfacing
My partner had one hip done 10 years ago with no subsequent problems.
She will travel to Belgium next month for this surgery on the other hip. Why another country? The FDA has not yet approved the smaller hardware she requires (the larger size is approved; re-approval is required because the manufacturer changed).
Why hasn't FDA approved? H&HS Secretary Tom Price owned stock in a competitor supplier and, if approved, that company would suffer short-term profit reduction. As a congressman he tried to delay an Obama-era rule that would make approvals easier. That company's PAC donated to Price's re-election war chest.
Now that he runs all of H&HS, don't expect that approval anytime soon.
https://en.wikipedia.org/wiki/Hip_resurfacing
My partner had one hip done 10 years ago with no subsequent problems.
She will travel to Belgium next month for this surgery on the other hip. Why another country? The FDA has not yet approved the smaller hardware she requires (the larger size is approved; re-approval is required because the manufacturer changed).
Why hasn't FDA approved? H&HS Secretary Tom Price owned stock in a competitor supplier and, if approved, that company would suffer short-term profit reduction. As a congressman he tried to delay an Obama-era rule that would make approvals easier. That company's PAC donated to Price's re-election war chest.
Now that he runs all of H&HS, don't expect that approval anytime soon.
206
Couldn't agree more. I had hip resurfacing done in as a 25yo in Belgium – probably the same surgeon. One of the best decisions I ever made. It's been 12 years and I have almost forgotten there was ever an issue...
2
Ah, I was specifically reading this article with hip resurfacing in mind. I had one hip done in 2013 and now need my other hip done. Last year, I inquired about the age limit for this procedure and was told that the device was no longer available in smaller sizes for women. I've kept in touch with my surgeon at the Cleveland Clinic and I will soon be seeing their new head of orthopedic surgery who uses another device that is FDA approved and used by several top surgeon (including Dr. De Smet in Belgium). This is not made by Tom Price's investment company (it's Conserve Plus by Wright Medical Group). For whatever reason my hips are bad--inflammation or wear and tear (having been a runner and avid cyclist, it's a bit more wear and tear than the average bear), I am not of the mind to postpone this kind of procedure. I want to be able to move, to be active and do the things I want and need to do (anyone ever tried picking weeds with a bad hip?) while the rest of my body and my mind is cooperating. These are my golden years and I want to enjoy them. Now, will insurance pay for this, that's the big question. My 2013 procedure was covered but I'm concerned, especially because I'll be on Medicare soon. Maybe I'll be doing some medical tourism to Belgium if not. For "younger" active people out there with bad hips, don't believe bad press on resurfacing. It's amazing, but you need to have a good surgeon.
3
Hi LEB-
I'm not trying to be contrarian, but I felt I needed to reply to your comment.
There are both plusses and minuses to both a traditional hip replacement and a hip resurfacing. I think to say 'it has several advantages over replacement' is not entirely true. I would not want somebody believing that a total hip replacement is somehow a inferior way to go compared to hip resurfacing.
I had one hip resurfaced 7 years ago. Knock-on-wood it has been doing great. Now, I am in need to replace my other arthritic hip and I am leaning towards a traditional total hip replacement on that hip. We'll see.
I think each individual person should do their research and find out what will work best for the them. Also, from all the studies I went over by far the most important factor in a hip replacement/resurfacing either anterior or posterior/etc is surgeon skill.
Regardless, I think we are very fortunate to live in a period where joints can be replaced! :) If anybody reading this is suffering from severe arthritis and is hesitant to go under the knife I can tell you from experience that replacing my hip made me get back to my good life in may ways.
Good health to all who may have read this.
I'm not trying to be contrarian, but I felt I needed to reply to your comment.
There are both plusses and minuses to both a traditional hip replacement and a hip resurfacing. I think to say 'it has several advantages over replacement' is not entirely true. I would not want somebody believing that a total hip replacement is somehow a inferior way to go compared to hip resurfacing.
I had one hip resurfaced 7 years ago. Knock-on-wood it has been doing great. Now, I am in need to replace my other arthritic hip and I am leaning towards a traditional total hip replacement on that hip. We'll see.
I think each individual person should do their research and find out what will work best for the them. Also, from all the studies I went over by far the most important factor in a hip replacement/resurfacing either anterior or posterior/etc is surgeon skill.
Regardless, I think we are very fortunate to live in a period where joints can be replaced! :) If anybody reading this is suffering from severe arthritis and is hesitant to go under the knife I can tell you from experience that replacing my hip made me get back to my good life in may ways.
Good health to all who may have read this.
9
Home is almost always better than being in a hospital. Get out of those places as quickly as you can.
Even providing 24-48 hours of a home health aid for those patients who live alone would be better than sending the poor souls to a rehab center. And it would still save a ton of money!
Even providing 24-48 hours of a home health aid for those patients who live alone would be better than sending the poor souls to a rehab center. And it would still save a ton of money!
27
The cost of a rehab center is very similar to the cost of ONE home health aide, round the clock.
Some folks here think "home health aide" is a cheap solution. IT IS NOT. Not for a licensed, bonded worker. The agencies charge $22 in my area -- midwest! -- it must be 20% more in NYC or big cities.
There is a minimum of 4 hours a day and most post surgical patients need ROUND THE CLOCK care -- what if your 80 year old mom has to get out of bed during the night to use the bathroom? she could fall and end up far worse off! -- and round the lock care at $22 an hour is roughly $500 a day.
The nursing rehab in my area -- rated 5 stars -- was $444 a day, the last time my aunt used it in 2013.
Some folks here think "home health aide" is a cheap solution. IT IS NOT. Not for a licensed, bonded worker. The agencies charge $22 in my area -- midwest! -- it must be 20% more in NYC or big cities.
There is a minimum of 4 hours a day and most post surgical patients need ROUND THE CLOCK care -- what if your 80 year old mom has to get out of bed during the night to use the bathroom? she could fall and end up far worse off! -- and round the lock care at $22 an hour is roughly $500 a day.
The nursing rehab in my area -- rated 5 stars -- was $444 a day, the last time my aunt used it in 2013.
2
This surgery is still not affordable for millions of people with substandard insurance. Normal, working class people cannot afford the surgery or to stay at home not working for the recovery period since many businesses offer little or no disability pay. Saving money is great for people who have it but a lot of people don't "opt not to have surgery", it is completely out of reach.
96
Which is why most people who have knee/hip replacements are over 65 and on Medicare (with a GOOD Medigap policy as well!).
Without that -- without being retired and on Medicare -- the costs and loss of time would make this available only to relatively well-off folks with excellent employer benefits.
Without that -- without being retired and on Medicare -- the costs and loss of time would make this available only to relatively well-off folks with excellent employer benefits.
3
Advances in surgical techniques also have rendered traditional recovery modes obsolete. I had a full hip replacement using the anterior method and was out of the hospital within 30 hours, walking without any aid when I got home, took only Tylenol for a few days, had no PT, and had only two minor restrictions, which were lifted in 6 weeks. Went back to work at two weeks. I'm actually glad I held off for years, as the advances in technology are what allowed for this amazing experience. Although I have a husband at home to help, I could have definitely done the recovery on my own.
57
Very helpful article for me, as I work with a group of older people who have had or who are facing this kind of therapy.
A hidden factor in the success of rehab is the patient's motivation. A large number of the folks I work with retired from the nursing profession. They know outcomes, and they need no coaching to follow through on their treatment plans. Others still have an idea that medicine is magic: let the surgeon do the work and poof! you have a new pain-free joint, no exercise required on your part.
The patient's personality and tendencies need to be considered in a post-surgery rehabilitation plan. The magic group requires that 10 days of inpatient rehab, which for them should be thought of as "boot camp."
A hidden factor in the success of rehab is the patient's motivation. A large number of the folks I work with retired from the nursing profession. They know outcomes, and they need no coaching to follow through on their treatment plans. Others still have an idea that medicine is magic: let the surgeon do the work and poof! you have a new pain-free joint, no exercise required on your part.
The patient's personality and tendencies need to be considered in a post-surgery rehabilitation plan. The magic group requires that 10 days of inpatient rehab, which for them should be thought of as "boot camp."
28
Seriously, we had a family friend who basically gave up on rehab and was essentially no better off post-replacement than before. I always felt like she should have been required to reimburse Medicare for this waste.
A timely topic - you just got the jump on many of your peers!
It’s a surprise not that infections were less likely at home; but that they WERE attributed to substandard care in inpatient rehab.
A problem to be addressed before orthopedists and hospitals everywhere discharge all patients immediately post joint replacement is how to assure that there actually is a VIABLE plan in place. I’ve encountered the assumption that all of us have family to step in but with a lot of older singles that isn’t the case. So is important to incorporate real life planning into care plans. A patient may need help in accessing transportation, or making changes at home. Some hospitals do this beautifully, others fail. After care IS an integral part of regaining mobility and health, yet hospitals are not paid for this - -
Some day, please revisit the question of the TIMING of joint replacements. From your recounting of your own experiences back when, one take-away for me was that some people - female people - wait too long to undergo surgery, while their muscles and sense of balance deteriorate, making recovery
harder. But I've also read that having this surgery should be put off for as long as possible because the results do not justify the time expense and work until you absolutely must have it. Obviously no one undergoes joint replacement without serious reason - but is there any consensus - or evidence - for an optimum time?
It’s a surprise not that infections were less likely at home; but that they WERE attributed to substandard care in inpatient rehab.
A problem to be addressed before orthopedists and hospitals everywhere discharge all patients immediately post joint replacement is how to assure that there actually is a VIABLE plan in place. I’ve encountered the assumption that all of us have family to step in but with a lot of older singles that isn’t the case. So is important to incorporate real life planning into care plans. A patient may need help in accessing transportation, or making changes at home. Some hospitals do this beautifully, others fail. After care IS an integral part of regaining mobility and health, yet hospitals are not paid for this - -
Some day, please revisit the question of the TIMING of joint replacements. From your recounting of your own experiences back when, one take-away for me was that some people - female people - wait too long to undergo surgery, while their muscles and sense of balance deteriorate, making recovery
harder. But I've also read that having this surgery should be put off for as long as possible because the results do not justify the time expense and work until you absolutely must have it. Obviously no one undergoes joint replacement without serious reason - but is there any consensus - or evidence - for an optimum time?
46
I agree that a discussion of timing would be interesting.
I had a hip replacement done because physical therapy, mild painkillers and a single cortisone treatment did not provide significant relief and I was told that my arthritic joint would just continue to deteriorate.
The improvement was immediate and I am very happy I did not wait longer.
That said, it helped a lot that I am old enough to have had this covered mostly by Medicare.
And yes, I think it is possible to rehab at home with proper support.
I had a hip replacement done because physical therapy, mild painkillers and a single cortisone treatment did not provide significant relief and I was told that my arthritic joint would just continue to deteriorate.
The improvement was immediate and I am very happy I did not wait longer.
That said, it helped a lot that I am old enough to have had this covered mostly by Medicare.
And yes, I think it is possible to rehab at home with proper support.
11
FWIW, I'm 55 and have been told since I was in my mid-40s that I need both knees replaced. I know this and I know I'm bone on bone in both knees. I have stretched the time of having my replacements done by doing a variety of things - Synvisc injections, steroid injections, some PT and losing weight. I hope to get to 60 before having the knees done because I really don't want to have to have a revision - since my mother recently died at 94, I'm very likely to outlive the warranty on my new knees of 15-17 years. My orthopedic surgeon is in agreement. I will continue to be as active as I can and undergo a course of pre-op PT to strengthen my legs as I live in a house with only one bath on the second floor.
8
I have suspected that high dose vitamin c ( about 5 g a day of calcium ascorbate) antioxidants, minerals and other supplements such as MSM, have helped me play out the life of a knee that was very badly damaged many years ago in a sports accident. Applying a very small amount of castor oil (it is obnoxiously sticky if not used in small quantities) to the skin over the joint is anti-inflammatory. This knee lost the meniscus, and has been bone on bone for eons. Wobenzyme taken on an empty stomach with three big glasses of water reduced a huge amount of swelling which the surgeon who cleaned up the joint after it blocked, thought to be impossible to resolve because it looked so bad he thought it was rheumatoid arthritis. Wobemzyme reduces inflammation fairly naturally but cannot be used by those who have ulcers. Vitamin C contributes to building cartilage. Balanced hormones help maintain normal tissue growth. A good diet is important. The body's build up and tea drown mechanisms for building cartilage need to be in balance. Prof' D' Africa's therapy worked miracles for it, but it needs surgery to straighten the joint.
1